BROKEN LAWS,
BROKEN LIVES
Medical Evidence of Torture by
US Personnel and Its Impact

A Report by Physicians for Human Rights
June 2008

BROKEN LAWS,
BROKEN LIVES:
Medical Evidence of Torture by
US Personnel and Its Impact

A Report by Physicians for Human Rights
June 2008

© 2008, Physicians for Human Rights
All rights reserved.
ISBN: 1879707543
Library of Congress Number: 2008925849
Cover image: © Fernando Botero, courtesy, Marlborough Gallery, New York.
	
Detail from Abu Ghraib 44 (right panel), 2005, 191 x 107 cm
Report Design: Glenn Ruga/Visual Communications

Physicians for Human Rights

P

hysicians for Human Rights (PHR) mobilizes health
professionals to advance the health and dignity of
all people through actions that promote respect
for, protection of, and fulfillment of human rights. PHR
has a track record of more than 20 years documenting
torture around the world, including in Turkey, Chile,
Chechnya, Kosovo, Israel, India, and Chiapas, Mexico.
PHR has extensive expertise in evaluating survivors of
torture as well as experience with prisoner health issues.
PHR was one of the lead initiators and authors of the
Istanbul Protocol on the investigation and documentation
of torture, adopted as an official document by the United
Nations in 1999.
As one of the original steering committee members
of the International Campaign to Ban Landmines, PHR
shared the 1997 Nobel Prize for Peace.

About PHR’s Campaign Against
Torture
PHR has documented the systematic use of torture by the
United States during its interrogations of detainees at US
detention facilities, including those at Guantánamo Bay,
in Iraq and Afghanistan, and elsewhere. It has previously
published two groundbreaking reports on the human
impact and the legality of abusive interrogation tactics
authorized by the Bush Administration: Break Them
Down: Systematic Use of Psychological Torture by US Forces
and Leave No Marks: “Enhanced” Interrogation Techniques
and the Risk of Criminality. PHR has repeatedly called
for an end to the use of the “enhanced” tactics by all US
personnel, an end to all health professional participation

in interrogations, a full Congressional investigation of
the use of psychological and physical torture by the US
Government, and accountability for perpetrators.
PHR has successfully organized and mobilized thousands of health professionals and helped to secure the
leadership of the major health professional associations
to develop ethical guidelines related to interrogation that
protect against medicine and science being employed
to aid the abuse of prisoners. PHR’s work contributed
to the adoption of ethical standards by the American
Medical Association, the World Medical Association, and
the American Psychiatric Association prohibiting direct
participation of physicians in interrogations. PHR has
helped move the American Psychological Association (APA)
to prohibit the involvement of its members in the Central
Intelligence Agency’s “enhanced” interrogation techniques
and has supported a movement within the APA to end the
direct participation of psychologists in interrogations.
Physicians for Human Rights
2 Arrow Street, Suite 301
Cambridge, MA 02138
Tel. (617) 301.4200
Washington Office
1156 15th Street, Suite 1001
Washington, DC 20005
Tel. (202) 728.5335
www.physiciansforhumanrights

iii

iv

Table of Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . vi

Sleep Deprivation . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

List of Acronyms. . . . . . . . . . . . . . . . . . . . . . . . . . vii

Sexual, Religious, Cultural, and Other Forms of
Degrading Treatment. . . . . . . . . . . . . . . . . . . . . . . . 83

Executive Summary. . . . . . . . . . . . . . . . . . . . . . . . 1
Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Witnessing Torture and Cruel Treatment. . . . . . . . 84

Summary of Findings. . . . . . . . . . . . . . . . . . . . . . . . . 2

Health Professional Complicity and Denial of
Medical Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Legal Prohibitions Against Torture and
Ill-Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Response by US Personnel to ICRC Visits . . . . . . . 87

Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Chapter 5: Short-Term and Lasting Harm
from Torture and Ill-Treatment . . . . . . . . . . . .  89

Chapter 1: Introduction . . . . . . . . . . . . . . . . . . .  11

Acute Impact of Ill-Treatment. . . . . . . . . . . . . . . . . 89

Chapter 2: Methods . . . . . . . . . . . . . . . . . . . . . .  13
Identification of Study Population. . . . . . . . . . . . . . 13
Evaluators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Medical Evaluations in Accordance with the
Istanbul Protocol. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Source of Information for Medical Evaluations . . . 15
Human Subjects Protection. . . . . . . . . . . . . . . . . . . 15
Limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Chapter 3: Medical Evidence of Ill-Treatment
in US Detention Facilities. . . . . . . . . . . . . . . . . .  17
Chapter 4: Patterns of Torture and
Ill-Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . .  73
Beatings and Other Ill-Treatment During Arrest,
Transport, and Initial Custody. . . . . . . . . . . . . . . . . 73
Deprivation of Basic Necessities and Sanitary
Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Stress Positions: Forced-Standing, Handcuffing,
and Shackling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Isolation, Sensory Deprivation, or
Bombardment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Threats of Harm to Detainees and
Their Families. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Instilling Fear Through Use of Military Dogs . . . . . 80

Chronic Physical Consequences of
Ill-Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Lasting Psychological Consequences of
Ill-Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Diminution of Social and Work Life
After Detention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Chapter 6: Legal Analysis . . . . . . . . . . . . . . . . .  95
Legal Prohibitions Against Torture and
Ill-Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Systematic Torture by the United States. . . . . . . . . 98
Applicability of the Law to Acts Committed by US
Personnel Against Detainees. . . . . . . . . . . . . . . . . . 99
Reparations and Justice for Victims
of Torture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Chapter 7: Conclusion and
Recommendations . .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 113
Appendix I: Torture: Psychological
and Medical Consequences. .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 117
Psychological Trauma: The Common
Denominator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Physical Consequences of Torture . . . . . . . . . . . . 119
Physical Evidence of Torture . . . . . . . . . . . . . . . . . 120

Use of Temperature Extremes. . . . . . . . . . . . . . . . . 80
Beatings and Other Physical Assault . . . . . . . . . . . 81

v

Acknowledgments

T

he lead author for this report was Farnoosh
Hashemian, MPH, Research Associate, Physicians
for Human Rights (PHR), who was joined in
its writing by Sondra Crosby, MD, Boston Center for
Refugee Health and Human Rights; Vincent Iacopino,
MD, PhD, PHR Senior Medical Advisor; Allen Keller, MD,
Bellevue/NYU Program for Survivors of Torture; Leanh
Nguyen, PhD, Bellevue/NYU Program for Survivors of
Torture; Onder Ozkalipci, MD, International Rehabilitation
Council for Torture Victims; Christian Pross, MD, Berlin
Center for the Treatment of Torture Victims; and Juda
Strawczynski, LLB, former PHR Research Fellow.
Leonard Rubenstein, JD, PHR President, oversaw the
report and provided crucial guidance throughout on
report’s structure and content; Alicia Yamin, JD, MPH,
former PHR Director of Research and Investigations
oversaw the planning and implementation of the investigation its initial stages.
Scott Allen, MD, PHR Medicine as a Profession Fellow;
Vincent Iacopino, MD, PhD, PHR Senior Medical Advisor;
and Brigadier General Stephen Xenakis, MD, USA (Ret.)
offered detailed comments on the medical evaluations and,
along with Drs. Ozkalipci and Pross, reviewed the medical
records of one of the detainees held at Guantánamo.
Nathaniel Raymond, PHR Senior Communications
Strategist, reviewed, edited, and provided technical
expertise for the report. This report was edited and
prepared for publication by Tara Gingerich, JD.
This report has benefited from review by Shereef
Akeel, JD, Akeel & Valentine, PLC; Barbara Ayotte, former
PHR Director of Communications; John Bradshaw, JD,
PHR Director of Public Policy; Carolyn Patty Blum, JD,
Consultant, Center for Constitutional Rights; Susan
Burke, JD, Burke O’Neil, LLC; Colonel Daniel L. Cohen
MD, USAF (Ret.); Frank Davidoff, MD, and Vice President
PHR Board of Directors; Benjamin Davies, former PHR
Chief of Staff; Frank Donaghue, PHR Chief Executive
Officer; Sebnem Korur Fincanci, MD, Professor of
Forensic Medicine, Istanbul University; Justice Richard
J. Goldstone, Justice of the South African Constitutional
Court, Retired, and member of PHR Board of Directors;

vi

Emi MacLean, JD, Staff Attorney, Center for Constitutional
Rights; Paul Rocklin, JD, former PHR Senior Program
Associate; Barry Rosenfeld, PhD, Professor and Director
of Clinical Training, Fordham University; Susannah
Sirkin, PHR Deputy Director; and Ronald Waldman, MD,
MPH, Professor of Clinical Population and Family Health,
Mailman School of Public Health, Columbia University,
and member of PHR Board of Directors.
PHR is grateful for the dedication and extensive research assistance over many months by Klara
Bolen. The following individuals contributed to legal
and other research: Patrick Childress, Joanne Cossitt,
Jesse Hamlin, Louise Place, Brent Savoie, and Daniel
Scarvalone. Remy Gerstein and Majid Jumoor assisted
with the logistics and played an essential role in ensuring
that investigations were carried out successfully.
PHR extends special gratitude to the following organizations for their pivotal support: Akeel & Valentine, PLC,
Bellevue/NYU Program for Survivors of Torture, Berlin
Center for the Treatment of Torture Victims, Boston
Center for Refugee Health and Human Rights, Burke
O’Neil, LLC, Center for Constitutional Rights, Fordham
University, and International Rehabilitation Council for
Torture Victims. Two centers affiliated with IRCT facilitated the medical evaluations and made this investigation
possible; they cannot be named to protect the confidentiality of the participants.
PHR thanks the JEHT Foundation, the Morton and
Jane Blaustein Foundation, The Open Society Institute, and
The Herbert Block Foundation for financial support that
made this investigation and report possible.
PHR would like to acknowledge the artist Fernando
Botero for granting PHR permission to use one of the
paintings from his Abu Ghraib series on the cover of
this report.
We are most indebted, however, to the eleven former
detainees who were willing to share their painful experiences with us, sometimes at significant risk to themselves and their families.

List of Acronyms

BHS: 	

Behavioral Health Science Teams

CIA:	

Central Intelligence Agency

CIDT:	

Cruel, Inhuman, or Degrading Treatment

DoD:	

Department of Defense

DTA:	

Detainee Treatment Act of 2005

ECHR: 	 European Court of Human Rights
ERB: 	

Ethics Review Board

FBI:	

Federal Bureau of Investigation

IACHR: 	 Inter-American Court of Human Rights
ICRC:	

International Committee of the Red Cross

ICCPR: 	 International Covenant on Civil and
Political Rights
ICTR: 	

International Criminal Tribunal for Rwanda

ICTY: 	

International Criminal Tribunal for Yugoslavia

IRF: 	

Immediate Reaction Force

IRCT: 	

International Rehabilitation Council for
Torture Victims

MCA:	

Military Commissions Act of 2006

MDD: 	

Major Depressive Disorder

NOS: 	

Not Otherwise Specified

OLC:	

Office of Legal Counsel, Department
of Justice

PHR:	

Physicians for Human Rights

POW: 	

Prisoner of War

PTSD:	 Post-traumatic Stress Disorder
SERE:	 Survival, Evasion, Resistance, and
Escape training
SOP:	

Standard Operating Procedure

TVPA:	

Torture Victims Protection Act of 1991

WCA:	

War Crimes Act

vii

Preface

T

his report tells the largely untold human story of
what happened to detainees in our custody when
the Commander-in-Chief and those under him
authorized a systematic regime of torture.  This story is
not only written in words: It is scrawled for the rest of
these individual’s lives on their bodies and minds.  Our
national honor is stained by the indignity and inhumane
treatment these men received from their captors.
The profiles of these eleven former detainees, none
of whom were ever charged with a crime or told why
they were detained, are tragic and brutal rebuttals to
those who claim that torture is ever justified. Through
the experiences of these men in Iraq, Afghanistan, and
Guantanamo Bay, we can see the full-scope of the damage
this illegal and unsound policy has inflicted —both on
America’s institutions and our nation’s founding values,
which the military, intelligence services, and our justice
system are duty-bound to defend.
In order for these individuals to suffer the wanton
cruelty to which they were subjected, a government
policy was promulgated to the field whereby the Geneva
Conventions and the Uniform Code of Military Justice
were disregarded. The UN Convention Against Torture
was indiscriminately ignored. And the healing professions, including physicians and psychologists, became
complicit in the willful infliction of harm against those
the Hippocratic Oath demands they protect.

v i i i   B roken L aws , B roken L ives

After years of disclosures by government investigations, media accounts, and reports from human
rights organizations, there is no longer any doubt as to
whether the current administration has committed war
crimes. The only question that remains to be answered
is whether those who ordered the use of torture will be
held to account.
The former detainees in this report, each of whom
is fighting a lonely and difficult battle to rebuild his life,
require reparations for what they endured, comprehensive psycho-social and medical assistance, and even an
official apology from our government.
But most of all, these men deserve justice as required
under the tenets of international law and the United
States Constitution.  
And so do the American people.

Major General Antonio
Taguba, USA (Ret.)
Maj. General Taguba led the US Army’s official
investigation into the Abu Ghraib prisoner abuse
scandal and testified before Congress on his
findings in May, 2004.

Executive Summary

T

his report provides first-hand accounts and
medical evidence of torture and cruel, inhuman,
or degrading treatment or punishment (“illtreatment”1) of eleven former detainees who were held
in US custody overseas. Using internationally accepted
standards, Physicians for Human Rights (PHR) conducted
medical evaluations of the former detainees to document the severe, long-term physical and psychological
consequences that have resulted from the torture and illtreatment. The evaluations provide evidence of violation
of criminal laws prohibiting torture and of the commission of war crimes by US personnel.2
Four of the men evaluated were either arrested in or
brought to Afghanistan between late 2001 and early 2003
and later sent to Guantánamo Bay, Cuba, where they
were held for an average of three years before release
without charge. The other seven were detained in Iraq
in 2003 and released without charge later that year or in
2004, with an average period of detention of six months.
All of the former detainees evaluated by PHR reported
having been subjected to multiple forms of torture or
ill-treatment that often occurred in combination over a
long period of time.
The medical evaluations were based in each case
on intensive two-day clinical interviews that included
diagnostic testing and, in two cases, review of medical
records. With this evidentiary record, this report provides
the most detailed account available thus far of the experience of detainees in US custody who suffered torture — a

war crime — at the hands of US personnel. Additionally,
this report provides further evidence of the role health
professionals played in facilitating detainee abuse by
being present during torture and ill-treatment, denying
medical care to detainees, providing confidential medical
information to interrogators, and failing to stop or document detainee abuse.
Methods of torture experienced by the former
detainees evaluated by PHR included interrogation and
detention practices such as isolation, sleep deprivation,
forced nakedness, severe humiliation and degradation,
and sensory deprivation that were officially authorized
by military and civilian officials during certain periods
when these men were incarcerated.3 Additional practices recounted by the interviewees including beatings
and other forms of severe physical and sexual assault
that, while not officially authorized by government documents now part of the public record, came to be part of
a regime of brutality at the facilities where the detainees
were held.
This report demonstrates that the permissive environment created by implicit and explicit authorizations by
senior US officials to “take the gloves off”4 encouraged
forms of torture even beyond the draconian methods
approved at various times between 2002 and 2004.5 In an
environment of moral disengagement that countenances
authorized techniques designed to humiliate and dehumanize detainees, it is not surprising that other forms
Relevant documents containing these authorizations are included
in two published books: Jameel Jaffer & Amrit Singh, Administration of
Torture (2007); The Torture Papers: The Road to Abu Ghraib (Karen J.
Greenberg & Joshua L. Dratel eds., 2005).

3  

Ill-treatment refers to “cruel, inhuman or degrading treatment or
punishment” as is defined in the UN Convention Against Torture
and Other Cruel, Inhuman, or Degrading Treatment or Punishment.
Convention Against Torture and Other Cruel, Inhuman, or Degrading
Treatment or Punishment, G.A. Res. 39/46, U.N. GAOR. 39th Sess.
Supp. No. 51, entered into force June 26, 1987, U.N. Doc. A/Res/39/46,
available at http://www.unhchr.ch/html/menu3/b/h_cat39.htm [hereinafter UN Convention Against Torture].

1  

The definition of US personnel for the purpose of this report encompasses: service members with the US Armed Forces, US civilian
personnel of other government agencies outside the Department of
Defense, and US government private contractors. This definition is
intentionally broad due to the fact that the detainees evaluated often
knew little specific information about the affiliation of the personnel
at the facilities where they were held, other than that they were
Americans in most cases and often wore US military uniforms.

Cofer Black, head of the CIA’s counterterrorist center, famously told
a September 26, 2002 Congressional hearing, “After 9/11, the gloves
came off.” Joint Investigation Into September 11th: Hearing Before the
Joint House-Senate Intelligence Comm., 109th Cong. (2002) (statement
of Cofer Black, Former Chief of the Counterterrorist Center, Central
Intelligence Agency). According to a July 2007 Vanity Fair article,
William Haynes, General Counsel of the Department of Defense, told
the “admiral in charge of detainees in Afghanistan “to ‘take the gloves
off’ and ask whatever he wanted” in the questioning of John Walker
Lindh.” Katherine Eban, Rorschach and Awe, Vanity Fair Online, July 17,
2007. available at http://www.vanityfair.com/politics/features/2007/07/
torture200707?printable=true&currentPage=all.

4  

2  

5 

See supra note 3.
  1

of human cruelty such as physical and sexual assault
were practiced. The fact that these unauthorized torture
practices happened over extended periods of time at
multiple US detention facilities suggests that a permissive command environment existed across theatres and
at several levels in the chain-of-command. This climate
allowed both authorized and unauthorized techniques to
be practiced, apparently without consequence.
Given the limited number of detainees evaluated, the
findings of this assessment cannot be generalized to the
treatment of all detainees in US custody. The patterns of
abuse documented in this report, however, are consistent
with numerous governmental and independent investigations into allegations of detainee ill-treatment,6 making
it reasonable to conclude that these detainees were not
the only ones abused, but are representative of a much
larger number of detainees subjected to torture and illtreatment while in US custody.

Methods
PHR identified individuals through referring nongovernmental organizations and law firms that provide
legal representation to former and current detainees in
US custody. The evaluations were conducted between
December 2006 and September 2007, after consent was
obtained by the individuals. No former detainee PHR
Hina Shamsi, Human Rights First, Command’s Responsibility: Detainee
Deaths in U.S. Custody in Iraq and Afghanistan (2006), available at http://
www.humanrightsfirst.info/pdf/06221-etn-hrf-dic-rep-web.pdf;
Amnesty International, Cruel. Inhuman. Degrades us All. Stop Torture
and Ill-Treatment in the “War on Terror” (2005), available at http://web.
amnesty.org/library/index/engACT400102005; Human Rights Watch,
“No Blood, No Foul”: Soldiers’ Accounts Of Detainee Abuse In Iraq (2006),
available at http://www.hrw.org/reports/2006/us0706/ [hereinafter
HRW No Blood]; Gen. Randall Schmidt & Brig. Gen. John Furlow, U.S.
Army, Investigation into Fbi Allegations of Detainee Abuse at Guantanamo
Bay, Cuba Detention Facility (2005), available at http://www.defenselink.
mil/news/Jul2005/d20050714report.pdf [hereinafter Schmidt Report];
Major General Antonio Taguba, Article 15-6: Investigation of the 800th
Military Police Brigade (2004), available at http://www.globalsecurity.org/intell/library/reports/2004/800-mp-bde.htm [hereinafter
Taguba Report]; Situation of Detainees at Guantánamo Bay, U.N. ESCOR
Comm’n on Human Rights, 62nd Sess., Agenda Items 10-11, U.N.
Doc E/CN.4/2006/120 (2006), available at http://www.ohchr.org/
english/bodies/chr/docs/62chr/E.CN.4.2006.120_.pdf [hereinafter
UN Guantánamo report]; Allen S. Keller, Torture in Abu Ghraib, 49
Perspectives in Biology and Medicine 553 (2006), available at http://muse.
jhu.edu/login?uri=/journals/perspectives_in_biology_and_medicine/
v049/49.4fabrega.pdf; Office of the Inspector Gen., U.S. Dep’t of Justice, A
review of the FBI’s Involvement in and Observation of Detainee Interrogations
in Guantánamo Bay, Afghanistan, and Iraq (2008), available at http://www.
usdoj.gov/oig/special/s0805/final.pdf (relating interagency dissent
over the use of interrogation techniques considered to be illegal and
referrals of complaints about the tactics to the highest level of the
US government) [hereinafter OIG Report].

6  

2   B roken L aws , B roken L ives

located who was eligible and consented to an evaluation was excluded from the study. For each former
detainee, a team of two experienced clinicians evaluated the individual and documented allegations of torture
and ill-treatment in accordance with the guidelines for
assessing physical and psychological evidence of torture
set out in the Istanbul Protocol, Manual on the Effective
Investigation and Documentation of Torture and Other
Cruel, Inhuman or Degrading Treatment or Punishment
(hereafter Istanbul Protocol).7 Sources of information
for the medico-legal reports include the clinical interview, psychological testing, physical examinations and
medical diagnostic tests. The Guantánamo Bay detention
medical records of one individual and an independent
medical record of another former detainee were available
for review as well. In each case, the clinicians provided
opinions on possible torture and ill-treatment based on
correlations between individual allegations of torture
and specific physical and psychological evidence. They
found no evidence of deliberate exaggeration in any
case. The study was approved by PHR’s Ethics Review
Board. In order to protect confidentiality, the names of
the individuals evaluated were changed and information
that could potentially identify the former detainees has
been omitted.

Summary of Findings
Synopses of the Cases of Former Detainees
Profiled
The following summaries of three evaluations of the
eleven cases illustrate the torture and ill—treatment
that the detainees experienced and the resulting
long-term physical and psychological harm. The torture
and ill-treatment described were corroborated by the
medical evidence.
Kamal is in his late forties. He served in the Iraqi Army
during the 1980s and later became a businessman and
Imam of a local mosque. In September 2003 he was
arrested by US forces. At the time of his arrest, he was
beaten to the point of losing consciousness. After being
brought to Abu Ghraib prison, he was kept naked and
isolated in a cold dark room for three weeks, where both
during and in between interrogations he was frequently
beaten, including being hit on the head and in the jaw with
Office of the U.N. High Comm’r for Human Rights, Istanbul Protocol:
Manual on the Effective Investigation and Documentation of Torture
and Other Cruel, Inhuman or Degrading Treatment or Punishment,
U.N. Doc HR/P/PT/8/Rev.1 (1999), available at http://www.unhchr.
ch/pdf/8istprot.pdf [hereinafter Istanbul Protocol].

7  

a rifle and stabbed in the cheek with a screwdriver.
He was then placed in isolation in a urine-soaked
room for two months. When Kamal was allowed to wear
clothes, they were sometimes soaked in water to keep him
cold. On approximately ten occasions he was suspended
in a stress position, causing numbness that lasted for a
month. He was made to believe that his family members
were also in prison and that they were being raped and
tortured. He recounted, “[T]hey were telling me, making
me hear voices of children and women, and told me they
were my children and [wife].” He was eventually transferred to a tent area of Abu Ghraib, where he remained
for seven months until his release in June 2004.
PHR’s clinicians found physical and psychological
evidence consistent with the abuse Kamal reported.
He continues to experience chronic pain in his jaw and
numbness from the suspensions. He also meets diagnostic criteria for several psychiatric diagnoses, including
major depressive episodes, a panic disorder, and posttraumatic stress disorder (PTSD) that are attributable to
his experience in detention. Particularly striking is the
severity of Kamal’s depressive symptoms, with feelings
of hopelessness, worthlessness, and guilt, and difficulty
sleeping. His symptoms are indeed so severe that, in the
opinion of PHR’s clinicians, they would qualify him for
hospitalization in the United States. 	
Amir is in his late twenties and grew up in a Middle
Eastern country. He was a salesman before being
arrested by US forces in August 2003 in Iraq. After his
arrest, he was forced, while shackled, to stand naked
for at least five hours. For the next three days, he and
other detainees were deprived of sleep and forced to run
for long periods, during which time he injured his foot.
After Amir notified a soldier of the injury, the soldier
threw him against a wall and Amir lost consciousness.
Ultimately, he was taken to another location, where he
was kept in a small, dark room for almost a month while
being subjected to interrogations that involved shackling,
blindfolding, and humiliation. Approximately one month
later, he was transferred to Abu Ghraib. At first he was
not mistreated, but then was subjected to religious and
sexual humiliation, hooding, sleep deprivation, restraint
for hours while naked, and dousing with cold water. In
the most horrific incident Amir recalled experiencing, he
was placed in a foul-smelling room and forced to lay face
down in urine, while he was hit and kicked on his back
and side. Amir was then sodomized with a broomstick
and forced to howl like a dog while a soldier urinated
on him. After a soldier stepped on his genitals, he
fainted. In July 2004, he was transferred to the prison

at Camp Bucca, where he reported no abuse. He was
returned to Abu Ghraib in November 2004 and released
two days later.
Amir continues to experience physical symptoms
consistent with the abuse he reported. Physical examination revealed features consistent with his account,
including tenderness of one of his testicles and rectal
tearing. Psychologically, he continues to suffer from
debilitating symptoms of severe PTSD, disturbed sleep,
moodiness, anxiety, sexual dysfunction, hostility and
outbursts of anger, and very frequent suicidal thoughts.
He has changed from a stable provider for his family to an
unemployed man. Although stressors related to the war
in Iraq may exacerbate his symptoms, his most debilitating symptoms are attributable to his experience of
torture and sexual violation. “No sorrow can be compared
to my torture experience in jail,” he said. “That is the
reason for my sadness.”
Youssef is in his early thirties. Unable to find work in his
country of origin, he sought employment in Afghanistan.
In late 2001 or early 2002, Youssef was detained as he
attempted to cross the Afghanistan-Pakistan border
without a passport while trying to return home. He was
held in a Pakistani prison for two months, where he was
often shackled in unsanitary conditions and given little food.
During this time, he was interrogated by US personnel
and eventually hooded, shackled, and transferred to the
US detention facility in Kandahar, Afghanistan.
In Kandahar, Youssef was immediately interrogated
and subjected to beatings with sticks and fists as well as
kicking, although he did not sustain serious injuries at the
time. After that, he was stripped naked. The first night he
was not allowed to sleep, as guards hit the detainees and
threw sand at them. While in Kandahar, Youssef endured
forced nakedness, intimidation by dogs, hooding, and
repeated assaults by being thrown against a wall. He was
subjected to electric shock from a generator, feeling “as
if my veins were being pulled out.”
After about six weeks, he was transferred to the US
detention facility at Guantánamo Bay, Cuba. During the
transatlantic flight he was dressed in an orange suit,
fitted with dark goggles and headphones and shackled
to the floor of the plane. The tight cuffs caused his wrists
to swell. Upon arrival, he was stripped, sprayed with
water and examined by a doctor. Like other detainees,
he described the conditions at Camp X-Ray as deplorable, with detainees living in cages that were extremely
hot and denied anything but a bucket for a toilet. In Camp
X-Ray lengthy interrogations accompanied by sleep
deprivation began. Small infractions such as speaking
  E xecutive summary  3

with other detainees led to beatings, and a person whom
he perceived to be a doctor checked the injuries of the
detainees after the beatings. In order to avoid beatings,
Youssef was compliant. Nevertheless, the Immediate
Reaction Force (IRF) team forced him into stress positions, including sitting on his knees with his hands
pressed together behind his back or head and tied to
his feet, forcing his legs up.
After approximately three months, Youssef and others
were transferred to Camp Delta, where general cell
conditions were better, although detainees were rarely
let out of their cells. He was beaten once for hiding food
in his cell. An IRF team also sprayed him in the eyes with
what may have been pepper spray, so that “my whole
body would feel like it was burning — not just my face,
but my whole body…I felt like I was losing consciousness
from the burning.”
His interrogations, which took place almost every
other day during his initial period at Guantánamo and he
would be kept in the interrogation room for as long as
eighteen to twenty hours. He denied having been beaten
during the lengthy interrogations or while being held in
the interrogation room. Youssef described these episodes
as some of his most painful experiences at Guantánamo.
He was chained and forced to assume stressful positions; at times, ice-water was poured on him and, at
other times, loud music was played. He was deprived
of access to the toilet and time for prayer. While being
held in the interrogation room, the temperature in the
room would be made extremely cold or hot for extended
periods of time. Demands for confessions were constant,
accompanied by claims by interrogators that his name
was found on documents and that his brother, who has
leukemia, had been arrested; soldiers also threatened
to shoot him. Humiliation was part of the interrogation regime: he was forced to look at pornography, and
soldiers ripped the Koran apart and threw it in the toilet
in front of him. He described being horrified by an incident in which a naked woman entered the interrogation
room and smeared what he believed to be menstrual blood
on him. He reported being given injections of unknown
substances against his will, and these injections often
caused rashes several hours later. He believes that in
some interrogations medical personnel were present and
that they examined him periodically. Although he was not
privy to the discussions between the medical personnel
and interrogators, it appeared to Youssef that that the
medical personnel were being consulted as to whether
interrogations should continue. They always did.
At one point while at Camp Delta at Guantánamo,
4   B roken L aws , B roken L ives

Youssef asked to speak with a psychologist because of
the distress and sadness he felt due to the separation
from his family. He believes that not only did his interrogators have access to the information he shared
with the psychologist, but that they exploited it by
threatening that he would spend the rest of his life in
Guantánamo. Following this interrogation session, he
was moved to what he believed to be the worst section
of Camp Delta, where he was not allowed to have a
blanket or mattress.
After being transferred out of Camp Delta and signing
a form, he was released in the fall of 2003. He was again
handcuffed and chained to the floor of the plane during
the lengthy flight. Upon returning home, he served over
a year of military service, during which he was mostly
confined in a psychiatric hospital because he was deemed
“too aggressive.”
On physical examination, Youssef was noted to have
surgical scars on his wrists consistent with his report of
surgery following his release for chronic wrist pain as a
result of shackling during his detention. Pain in his right
wrist still persists. He also has a scar on the back of his
left wrist consistent with the handcuffing he described.
While Youssef experienced symptoms of depression
before detention, PHR’s evaluators concluded that these
symptoms became more pronounced, disabling and
chronic as a result of his experience; he also now suffers
from moderate PTSD. Many of his physical symptoms,
including shortness of breath and “heart problems,” are
consistent with a panic disorder. Youssef acknowledged
difficulty functioning and has not found steady employment since his detention.

Common Experiences of Torture and
Ill-Treatment
Even though the eleven detainees examined by PHR were
held at different places, and each person’s experience
was unique, certain detention and interrogation practices appear over and over again in the accounts.

Beatings During Arrest, Transport, and Initial
Custody
Many of the most severe injuries from beatings that
the former detainees reported were sustained shortly
after they were arrested. All seven of the men who
were detained in Iraq (hereafter referred to as “the
Iraqi former detainees”) recounted experiencing violent
treatment during their arrests, some of which involved
severe physical assault on their family members as well
as destruction or looting of their homes.
The beatings inflicted on detainees at US facilities at

Bagram and Kandahar in Afghanistan were particularly
intense, and included beatings with sticks and fists, kicks
to the stomach and genitals and blows to the head. As a
result, Haydar, who was held at Kandahar before being
transferred to Guantánamo, lost three of his teeth and
Rasheed, who was held at both Bagram and Kandahar
facilities, lost consciousness and was hospitalized.
Similarly, all former detainees held at Guantánamo
reported that the most intense and widespread physical
beatings they experienced at the facility took place during
transfer and shortly after arrival there.
The Iraqi former detainees also reported severe beatings during the first days and weeks of detention at facilities including one at Baghdad International Airport. Hafez,
who was held at a US facility at Baghdad International
Airport and Abu Ghraib for over seven months, was forced
to the ground and beaten severely on his legs and back,
causing his lips, forehead, and nose to bleed; he also
reported being stripped and having his chest and pubic
hair ripped out by hand and being simultaneously beaten,
hit, and choked while being doused with cold water.
While physical evidence of beatings often may not be
detectable in later medical evaluations, findings from
bone scans of six of the former detainees as well as
scars and lesions visible during physical examination
are consistent with the history of beatings described by
the victims.

Deprivation of Basic Necessities and Sanitary
Conditions
All of the former detainees reported frequent denial
of basic necessities during periods of their detention;
over half of the men evaluated reported being denied
food on at least one occasion. Each former detainee
also reported being subjected to extreme temperatures
during his confinement.
The conditions detainees in Iraq endured were particularly appalling. Among the conditions one or more of
the detainees reported were placement in a urine-soaked
punishment room, being forced to wear soiled underwear,
often for weeks or months at a time, denial of access to
food, water and toilets of any kind, and exposure to cold
without blankets.
Two of the detainees who were held in Guantánamo
during the first year the facility was in operation reported
harsh physical conditions and being housed in steel
cages. Although as time passed, the physical conditions
improved there, deprivation sometimes accompanied
by acts of cruelty continued. Haydar reported that in
Guantánamo the soldiers would often either spit in or

throw out part of their food rations.

Stress Positions: Forced Standing, Handcuffing,
and Shackling
All of the former detainees reported having been
subjected to painful stress positions that involved having
their hands and feet bound for extended periods of times,
or suspension from walls or barbed wire. These positions were often coupled with the use of blindfolding,
sleep deprivation, isolation, and exposure to temperature extremes, either as components of interrogations
or conditions of confinement.
For example, three former detainees evaluated by
PHR reported that in Guantánamo they were kept in
extremely hot or cold interrogation rooms, chained in a
crouching position to a ring on the floor for eighteen to
twenty hours. Two of the Iraqi former detainees reported
losing consciousness as a result of being subjected to
stress positions.
Findings on medical examination were consistent with
these accounts. All of the former detainees reported that
they continue to suffer from a wide range of musculoskeletal pains. For example, Laith, an Iraqi former detainee
who was held in Abu Ghraib for nine months, reported
arm numbness and weakness following being suspended
by his arms, which is highly consistent with a brachial
plexus (nerve group supplying the upper extremity) injury
that often results from suspension.

Isolation, Sensory Deprivation, or Bombardment
A) Prolonged Isolation
All of the former detainees reported being subjected
repeatedly to lengthy periods of isolation that ranged
from ten days to as long as two months in duration. The
interviewees reported that, while being kept in isolation, they were subjected to shackling, blindfolding,
physical abuse, humiliation, sexual humiliation, and
stress positions, as well as temperature extremes and
light control.
During periods of isolation, the Iraqi former detainees
consistently reported being kept hooded and naked in
small, dark holding cells that made Rahman, who was
held at Abu Ghraib for nine months, feel “claustrophobic.”
Similarly, former Guantánamo detainees reported that
they were repeatedly held in isolation. The psychological impact of isolation and other forms of abuse was
enormous. Rasheed engaged in hunger strikes, exhibited psychotic behavior, and even became suicidal after
prolonged isolation.

  E xecutive summary  5

B) Hooding/Blindfolding
Sensory deprivation by means of hooding or other types
of blindfolding was frequently used in combination with
other techniques in the places the former detainees were
held (Afghanistan, Iraq, and Guantánamo Bay, Cuba).
According to the detainees, blindfolding and hooding
instilled in them a sense of fear, disorientation, and
dependency on their captors.
According to the detainees evaluated, sensory deprivation was employed in Afghanistan during arrest and
transportation between facilities as well as during
interrogations. At Guantánamo, however, the four
detainees evaluated experienced hooding only when
being transferred. In Iraq, hooding was routinely used
during interrogations and general detention and was
combined with forced nakedness and isolation, among
other techniques.
C) Sensory Bombardment
Eight former detainees reported that sensory bombardment with loud noise or music was utilized frequently
in what appeared to be a strategy to disorient them or
disrupt detainees’ sleep.
The detainees who were held in Afghanistan reported
that they were subjected to loud music over long periods
of time, and in one case exposed to powerful flood lights
twenty-four hours a day. At Guantánamo, Rasheed
reported that during a period of isolation and frequent
lengthy interrogations, his cell was bombarded with loud
unpleasant noise.
The former detainees reported that in Iraq this technique was combined with forced running, isolation, and
sleep deprivation. Similar to three other Iraqi former
detainees, Morad, who was held in various facilities for
a total duration of ten months, was subjected to “deafening, loud music” while being held in Saddam Hussein’s
former ranch (used as a US detention facility).

Threats of Harm to Detainees and Their Families
Almost all of the detainees reported being threatened with severe harm, most commonly through verbal
threats during interrogations. Eight of the eleven men
reported that the US military utilized dogs to instill fear
in the detainees. Two of the Iraqi former detainees were
threatened with execution, and two others were threatened with forced disappearance since they did not have
prisoner identification numbers, were unregistered, and
therefore considered “ghost” detainees. Youssef recalled
being threatened with being shot by a guard during an
interrogation in Guantánamo.
6   B roken L aws , B roken L ives

Interrogators also told detainees that their families
would be killed or severely harmed. Laith told PHR that
the interrogators “were threatening me…they were saying
‘Then you will hear your mothers and sisters when we are
raping them.’” Interrogators also threatened detainees
with harm or torture following their release. Strikingly,
transfer to Guantánamo was a threat used on half of
the former detainees held in Iraq. Yasser recalled being
told he would be sent to Guantánamo “where even dogs
won’t live.”

Use of Extreme Temperatures
All of the former detainees reported being exposed to
extremes of temperature in their cells. For some of the
Iraqi former detainees, this practice was coupled with
weeks of isolation and sexual humiliation; for others,
this practice was used as a form of group punishment.
Four detainees, of whom three were held in Guantánamo,
reported that cold water was poured on them during
interrogation. In the cases of three individuals who were
held in facilities in Iraq, cold water was used in combination with lengthy interrogations, sensory bombardment,
beatings, and sexual humiliation.

Electric Shocks, Sexual Assault, and Physical
Assault
In addition to the beatings upon arrest, initial
detention and transfer described earlier, some of the
detainees were physically assaulted again later during
their detention. Two former detainees were sodomized
with a broomstick or a rifle at Abu Ghraib and three were
subjected to electric shock (two in Iraq and one while at
Kandahar, Afghanistan).
Physical assaults during detention included being
kicked, stepped on, dragged, slapped, and forcefully
thrown against a wall. Adeel, who was later transferred
to Guantánamo Bay, reported receiving daily beatings
while he was held at the Bagram facility. The Iraqi former
detainees described being struck with a rifle, stabbed
in the cheek with a screwdriver, burned on the chest
with a cigarette, and other episodes of severe physical
abuse during interrogations that in some cases resulted
in loss of consciousness. Five former detainees reported
soldiers exploiting detainees’ injuries. For example,
Yasser, who was held at Abu Ghraib for four months,
stated that his injured hand was deliberately stepped on
and squeezed by soldiers at Abu Ghraib.
Of the Guantánamo detainees, only one reported
routine physical abuse: Rasheed reported frequent beatings and one episode of harsh beatings during an interrogation. Youssef and Haydar stated that multiple times

the IRF teams (referred to by the former detainees as
the “riot police”) subjected them to chemical spray and
pressurized water, which left Haydar “writhing on the
ground in pain.”
Many of the physical assaults reported would likely
have resulted in bruises and soft tissue injuries that
would not leave lasting physical marks. However, the
bone scan findings of six individuals, and scars and
healed lesions observed on physical examination of
all detainees corroborated their specific allegations
of physical assault. Scarring on Yasser’s thumbs was
highly consistent with the scarring caused by electric
shock. Further, reports of rape and sexual assault were
corroborated in two cases by medical examination.

Sleep Deprivation
Nine of the eleven former detainees evaluated reported
that they were often subjected to sleep deprivation, in
combination with other techniques, through loud noise
or banging, use of cold water, or stress positions. Laith
explained: “If you ask me about being chained to the
window [standing], it was every day. They were especially
doing that at night, to prevent me from me sleeping.”

Sexual, Religious, Cultural, and Other Forms of
Degrading Treatment
According to detainee accounts, humiliation was
pervasive in detention facilities in both Iraq and Afghanistan.
Guards taunted, shamed, insulted, spat and urinated
upon, and embarrassed detainees, forced most to be
naked, observed some on the toilet, wrote degrading
phrases in indelible marker on the body of one, and forcibly cut the beards and shaved the heads of others. In
one incident, Amir reported having been pulled by a leather
dog leash in Abu Ghraib and was ordered to “howl like
dogs do.” He was repeatedly kicked when he refused
to do so.
Cultural and religious humiliation was reported by
more than half of the individuals evaluated, and took many
forms, including taunting men at prayer and desecrating the Koran. Rasheed stated that in protest of such
practices, detainees in all five blocks of Guantánamo
held a simultaneous uprising by banging their heads
against the walls and demanding “an end to the mocking
of their religion.”
One of the worst forms of humiliation detainees
reported, though, was sexual, and it was reported by virtually all of the individuals evaluated by PHR, at facilities
in Afghanistan, at Guantánamo, and in Iraq. The forms
of sexual humiliation were as varied as they were cruel:
parading men naked in front of female soldiers, forcing

them to disrobe before female interrogators, touching or
provoking them in a humiliating way, and forcing them to
watch pornography or real or feigned sexual activities.
Furthermore, nakedness became the normal mode of
operation in the Iraqi detention facilities, especially in
Abu Ghraib, where the detainees were forced to be naked
for long periods of time. Kamal stated that his genitals
were touched multiple times during interrogations in Abu
Ghraib. Further, he reported that when the American
soldiers “got me naked, they used to bring all female
soldiers to look at me and say, ‘Hello, Imam’.”

Witnessing Torture and Cruel Treatment
More than half of the former detainees evaluated
by PHR recounted witnessing torture and other cruel,
inhuman or degrading treatment towards other detainees
by US personnel. Two detainees witnessed other detainees
being bitten by dogs; others witnessed detainees being
subjected to various forms of sexual humiliation. In Abu
Ghraib, Rahman recounted that he was forced to watch
other detainees being forced to simulate anal intercourse
and recalled that the detainees “were begging, ‘This is a
sin against our religion, please show mercy.’ The soldiers
were pushing them into each other, and these guys were
trying to push away, and this was more than half an hour
and this was in front of our eyes.”

Health Professional Complicity and Denial of
Medical Care
Health professionals in detention settings are required by
domestic and international standards not only to provide
medical care to detainees but to protect their health and
well-being. A few of the former detainees reported that
they received appropriate care from health professionals
while in US custody.8 Adeel was diagnosed and treated
for tuberculosis while detained in Guantánamo, and
Morad received “humane treatment” from a doctor for
his diabetic foot ulcer.
At the same time, former detainees reported that
medical personnel played a role in facilitating torture
and ill-treatment in all three theatres of operations
through the monitoring of abuse during interrogations,
providing medical information to interrogators, denying
medical care, and failing to take action to stop and/or
document detainee abuse. Three of the Iraqi former
detainees and one former Guantánamo detainee reported
that individuals acting in a health professional capacity
examined their condition during an episode of torture or
The detainees often did not know what kind of health personnel interacted with them (e.g., doctor, nurse, medic, or psychologist).

8  

  E xecutive summary  7

physical abuse but made no effort to stop it. Two former
Guantánamo detainees suspected that the psychologist
shared information about them with interrogators.
Several men reported facing difficulties accessing
care while in detention. At Guantánamo, Youssef
recounted that he never received treatment despite
his “many, many” requests for medical attention to his
persistent stomach pain, as well as for swelling in his
wrists. Two men detained at Abu Ghraib reported being
denied medical treatment, including for injuries inflicted
by soldiers. In response to PHR’s query whether or not
any doctors treated Amir’s injuries in Abu Ghraib; he
responded: “Did I need to ask for help? I was there naked
and bleeding… .These were not real doctors.”
In addition, all the former detainees from Guantánamo
reported that they were given injections or medication
without their consent and medical procedures were
performed on them against their will.
The medical records of one of the former detainees,
Rasheed, illuminate the role of medical personnel at
Guantánamo, and PHR’s evaluators were able to compare
his account with entries in his medical file. The records
are largely consistent with his own account: shortly after
arriving at Guantánamo in 2002, Rasheed’s mental health
began to deteriorate; he attempted suicide and other acts
of self-harm, including self-mutilation. Mental health
staff at Guantánamo responded with heavy doses of
medication, which made him feel unbearably hot and
made his skin and joints ache. When his acts of selfharm continued, medical staff placed him in restraints
and treated his access to bottled water and blankets as
privileges. In response to his repeated requested to be
removed from isolation, the medical files note that the
psychiatric personnel “informed him that [they] had no
control over that and told him to ask his interrogator to
have him moved.”
It is not clear exactly how long Rasheed was kept in
isolation or how long Rasheed’s interrogations continued
after his severe signs and symptoms appeared —
although it appears to have been at least one year. What
is clear, though, is that during the critical periods in
2002 and 2003 when his health severely deteriorated,
his health condition did not result in halting interrogations, nor in relieving a regime of isolation and sleep
deprivation; nor do the records indicate that the medical
staff connected his ill-treatment — including use of isolation, sleep deprivation, physical assault, violation of his
religious and moral codes, and the use of sexual humiliation — to the obvious decline in his mental condition.
Nor is there evidence from the records that the medical
8   B roken L aws , B roken L ives

staff intervened to end his torture, except for one note
with a recommendation that resulted in a brief move out
of isolation. Instead, the thinking of the medical staff
appears reflected in a medical note that mentions him
being subject to “routine stressors of confinement.”
Further, one of the most likely diagnoses for Rasheed’s
psychological symptoms, PTSD, is never mentioned in
the medical record. The medical staff thus not only failed
to document that Rasheed was being tortured through
the use of isolation and other methods (and presumably
did not report it), but also became complicit themselves
in his abuse. Indeed their mental health interventions
may have worsened Rasheed’s suffering by patching
him up so that further interrogation and torture could
be inflicted.

Short-Term and Lasting Harm from Torture
and Ill-Treatment
All the detainees experienced severe, even excruciating
physical pain from being kicked, punched, choked,
shocked or sodomized, and many were terrorized by both
the experience of the assaults on them and threats of
more to come. Most of the detainees lost consciousness
at least once as a result of beatings or other physical
assaults. Some experienced bruising and trauma to
their genitals. Some of the men were not only severely
injured as a result of torture, but they then had to endure
additional pain from the exploitation of those injuries by
their tormenters. Almost all of the men PHR interviewed
continue to experience physical after-effects from the
torture they experienced, including chronic headaches as
well as persistent pain in their limbs, joints, back, muscles,
and ligaments from being beaten or kept suspended or
in other stress positions for long periods of time.
The experience of torture was horrifying to the men as
it was taking place. Men experienced shame, humiliation,
and terror that they or their loved ones would suffer even
more; others were terrified by the claustrophobic conditions of isolation. These in turn brought about symptoms
ranging from chest pain to severe anxiety to sleeplessness. One reported: “I was having really bad nightmares…
I felt like I couldn’t breathe.” According to medical files,
during an interrogation session in Guantánamo one
detainee had a seizure and “was unresponsive and fell…
[while] his feet [were] buckled.”

Lasting Psychological Consequences
of Ill-Treatment
With one exception, the former detainees have experienced and continue to experience severe psychological
effects of torture and ill-treatment as a result of their

detention in US custody. All but one feel utterly hopeless
and isolated, and lack the ability to sleep well, work, or
engage in normal social relationships with their families. Seven individuals disclosed having contemplated
suicide either while in detention or after being released.
Most of the released detainees, to this day, live with
severe anxiety, depression, and post-traumatic stress
disorder, including intrusive recollections of trauma
suffered in detention, hyperarousal (persistent symptoms of increased arousal, e.g., difficulty falling or
staying asleep, anger, and hypervigilance), avoidance
and emotional numbing behavior. PHR’s clinicians determined that these symptoms were directly related to the
torture and ill-treatment reported having taken place
while in US custody, even after taking into account the
fact that the released Iraqi former detainees are living
in a war-torn environment. Amir explained, “These are
the memories that I can never forget. I want to forget,
but it is impossible.”
For the four detainees who had experienced symptoms
of depression or other mental disorders prior to detention, torture and ill-treatment by the US Personell severely
exacerbated these conditions, and in one case it ignited
such deep despair and dysfunction as to lead the detainee
to repeated suicide attempts while at Guantánamo.

Diminution of Social and work Life After Detention
Many former detainees reported encountering social
stigma and fear in their communities as a result of their
status as former US detainees. Some relocated, and others
attempted to do so unsuccessfully. All except one have
lost their livelihood and are facing financial hardships,
and many were concerned about their physical safety and
security. These fears are not unfounded as three Iraqi
former detainees were rearrested and detained by both
American forces and the Iraqi government, though subsequently released. Since the interviews were completed,
PHR has authoritatively learned that one of the former
Guantánamo interviewees has been arrested in his home
country and is still being detained.

Legal Prohibitions Against Torture
and Ill-Treatment
All of the abusive interrogation techniques and patterns
of ill-treatment endured by these eleven men — including
beatings and other forms of severe physical and sexual
assault, isolation, sleep deprivation, forced nakedness,
severe humiliation and degradation, and sensory deprivation,
many of which were experienced over long periods of time and
often in combination with other prohibited acts — constituted

acts of torture as well as cruel, inhuman or degrading
treatment under domestic criminal statutes and international human rights and humanitarian treaties, including
the Convention Against Torture and the Geneva Conventions,
that were in effect at the time the acts were committed.
According to courts and entities responsible for interpreting the Convention Against Torture, including the UN
Special Rapporteur on Torture and the UN Committee
Against Torture, each of the interrogation techniques
and conditions of incarceration and treatment identified in this report, when considered on its own, constitutes prohibited conduct in the form of torture or cruel,
inhuman or degrading treatment or punishment. In
fulfilling its obligation to assess and report upon the
human rights conditions in other countries, the US State
Department relies upon international human rights treaties including the Convention Against Torture; in innumerable instances, it has identified the very practices
evidenced by this study, when committed in foreign countries, as torture or cruel, inhuman or degrading treatment or punishment. In addition, based on the severity
of physical and psychological pain and suffering caused
by these practices, the Istanbul Protocol has determined
that they constitute torture and/or ill-treatment.9 Likewise,
the medico-legal evidence leaves little doubt that the interrogation methods used by US personnel constitute torture
under the US Torture Act,10 the Uniform Code of Military
Justice (UCMJ),11 and other laws.

Recommendations
Based on the findings of this investigation, the United
States should take the following actions:
1.	 The executive branch must repudiate all forms of
torture and cruel, inhuman or degrading treatment.
It should explicitly and in writing establish a uniform
standard of conduct for all agencies that prohibits
any of its military, intelligence or other officials,
including all forms of contract personnel, from
engaging in torture and cruel, inhuman or degrading
treatment, including but not limited to any of the
following interrogation or conditions of confinement
methods, either alone or in combination:
• Stress positions
• Beatings and other forms of physical assault
9 

Istanbul Protocol, supra note 7, ¶ 144, at 28.
Torture Convention Implementation Act of 1994, 18 U.S.C.A. § 2340
(2004).

10  

11 

Uniform Code of Military Justice, 10 U.S.C. §§ 801—946 (2007).
  E xecutive summary  9

• Use of extremes of temperature
• Waterboarding or any other form of simulated
drowning12
• Threats of harm to the detainee, his family, or
friends
• Sleep deprivation
• Sensory bombardment through the use of
extreme noise and/or light
• Violent shaking
• Religious, cultural, and sexual humiliation
including, but not limited to, forced nakedness
• Prolonged isolation
• Sensory deprivation, including, but not limited
to, hooding and blindfolding
• Use of psychotropic, mind-altering, or other
drugs for the purpose of decreasing resistance
or gaining information
• Mock execution
• Exploitation of phobias, psychopathology, or
physical vulnerability
• Rape and sexual assault
• Electric shocks
• Deprivation of basic necessities and sanitary
conditions
Congress should enact into law the prohibitions listed
above and establish criminal liability for their violation.
2.	 The executive branch and Congress should establish
an independent commission to fully investigate and
publicly report on the circumstances of detention
and interrogation in Bagram, Kandahar, and elsewhere in Afghanistan, Iraq, Guantánamo Bay, and other
locations since 2001. This independent commission
should have subpoena power to compel witnesses
and have full access to all classified materials
concerning interrogation techniques and conditions
of detention, including medical records and documentation by behavioral health science consultant
personnel, in order to establish a full public record.
The investigation should extend to individuals in the
position of making policy as well as those who carried
those policies out, including all healthcare profes12 

None of the detainees evaluated experienced waterboarding.

1 0   B roken L aws , B roken L ives

sionals who were in the position of providing care or
supporting the interrogation of detainees.
3.	 All individuals who played any role in the torture
or ill-treatment of detainees, including those
who authorized the use of methods amounting to
torture or exercised command authority over them,
should be held to account through criminal and civil
processes (such as disciplinary action). Officials at
every level should be held accountable for crimes
they committed or for the acts of officials subordinate to them. Health professionals, both civilian
and uniformed, who engaged in or facilitated the
abuse of detainees and/or failed to report torture
and ill-treatment should be investigated, appropriately sanctioned, and disciplined via the Department
of Defense, other executive branch agencies, and
state licensing boards.
4.	 The government should issue a formal apology to
detainees who were subjected to torture and/or illtreatment as part of US military and intelligence
operations since fall 2001 in Afghanistan, Iraq,
Guantánamo Bay, Cuba, and elsewhere.
5.	 The government should establish a fair process for
compensation and victim assistance, including
access to rehabilitation and re-integration services, for
individuals subjected to torture or ill-treatment in
US custody.
6.	 All places of detention operated by the United States
should be subject to monitoring by international
bodies that investigate detainee treatment and
are capable of reporting findings to the public and
government, including the UN Special Rapporteur
on Torture, the UN Committee Against Torture, and
the International Committee of the Red Cross. These
organizations tasked by treaties to which the United
States is a party must be granted full access to
detainees, their medical records, and all other pertinent files documenting past and current treatment
of detainees during their incarceration. Furthermore,
Congressional and executive branch oversight of
US military and intelligence activities relevant to
detainee treatment and interrogation should be
immediately strengthened and improved.
7.	 The US Department of Justice should publicly
release all legal opinions and other memoranda
concerning standards regarding interrogation and
detention policy and practices.

I. Introduction

T

his report recounts and evaluates the experiences
of eleven men who were detained by the United
States in Afghanistan, Iraq, and Guantánamo Bay,
Cuba who allege they were tortured and abused before
being released without charge.
Physicians for Human Rights conducted rigorous,
in-depth clinical interviews with the former detainees
held in US custody, seven of them in Iraq, and four at
Afghanistan and Guantánamo Bay facilities. These interviews, each conducted by an internist and a psychologist
or psychiatrist, do more than merely allow the voices of
the released detainees to be heard. Because the information gathered from the former detainees is supported by
extensive medical evaluations — based on the Istanbul
Protocol,13 an internationally accepted standard on documenting torture — as well as psychological and medical
diagnostic tests and, in, one case, medical records from
Guantánamo, the report provides the most detailed
accounts of the torture of detainees over extended periods
of times by US personnel published thus far. The medical
evidence, gathered by experienced clinicians, strongly
corroborates the detainees’ accounts of torture and illtreatment. The findings of the report also bring to light
the significant and long-term harm the former detainees
have suffered as a result of their treatment.
It is now recognized that after September 11, 2001,
officials within the Bush Administration radically
changed the manner in which detainees in US custody
were treated and interrogated. Administration officials,
including White House and Department of Justice lawyers,
denied the full protection of the Geneva Conventions to
certain detainees in US custody and re-interpreted US
laws and international treaties14 so as to permit inter-

13 

Istanbul Protocol, supra note 7.
See, e.g., Jan Crawford Greenburg, Howard L. Rosenberg & Ariane
de Vogue, Bush Aware of Advisers’ Interrogation Talks, ABC News,
April 11, 2008, at http://abcnews.go.com/TheLaw/LawPolitics/
story?id=4635175&; Memorandum from Jay Bybee, Assistant
Attorney General, Office of Legal Counsel, Department of Justice
to Alberto R. Gonzales, Counsel to the President (August 1, 2002),
available at http://www.washingtonpost.com/wp-srv/nation/documents/dojinterrogationmemo20020801.pdf [hereinafter Bybee
Memo]; Memorandum from Daniel Levin, Acting Assistant Attorney
General, Office of Legal Counsel, Department of Justice, to James

rogation techniques previously found to be unlawful by
courts and oversight bodies responsible for reporting
on torture. These techniques had also been classified
as human rights abuses by the US State Department
when perpetrated by other countries.15 The public record
now abundantly shows how, starting in 2002, the Defense
Department began authorizing the use of highly coercive
interrogation methods, among them long-term isolation,
stress positions, severe humiliation, and sensory deprivation, first at Guantánamo Bay and later in Iraq.16 While
a few low-level military personnel have been prosecuted
for their actions in prisoner abuse, officials higher up
the military and civilian chains of command have not yet
been held to account.
In previous publications, Physicians for Human Rights
has reviewed scientific and medical literature and clinical
experience about highly coercive interrogation methods
and demonstrated that US “enhanced” interrogation
techniques, whether inflicted alone or in combination,
can cause severe physical and psychological pain and
suffering.17 This report reviews the experiences of eleven
men who were detained by the United States and actually endured the newly-authorized methods. Moreover,
it shows that, once certain highly coercive interrogation

B. Comey, Deputy Attorney General (December 30, 2004), available at
http://www.usdoj.gov/olc/dagmemo.pdf. The American Civil Liberties
Union (ACLU) also alleges that the Office of Legal Counsel issued an
August 2002 legal memorandum specifying “interrogation methods
that the CIA may use against top al-Qaeda members.” Dan Eggen,
CIA Acknowledges 2 Interrogation Memos: Papers Called Too Sensitive
for Release, Wash. Post, Nov. 14, 2006, at A29, available at http://
www.washingtonpost.com/wp-dyn/content/article/2006/11/13/
AR2006111301221.html.
For more information on the legal standards and US State Department
human rights findings, see infra Chapter 6.

15  

14  

16 

See supra note 3.
Physicians for Human Rights, Break Them Down: The Systematic Use of
Psychological Torture by US Forces (2005), available at http://physiciansforhumanrights.org/library/report-2005-may.html [hereinafter
PHR Break Them Down]; Physicians for Human Rights & Human Rights
First, Leave No Marks (2005), available at http://physiciansforhumanrights.org/library/report-2007-08-02.html [hereinafter PHR Leave
No Marks].

17  

  11

methods intended to humiliate and “dehumanize”18 the
detainees were permitted, other extreme violations that
apparently were not specifically authorized, including
electric shocks, beatings and sexual assault, including
rape, were employed. Hence, both authorized and unauthorized techniques documented in this report are part
of the overall regime of torture.
The report contains graphic descriptions of the men’s
experiences of beatings, forced nakedness, threats to
their lives and those of their families, sexual assault,
temperature extremes, sensory deprivation and
bombardment, sleep deprivation, and more during the
course of their incarceration, and how the methods were
often used in combination and employed for months at a
time. The report further reveals both the severe immediate pain and suffering that these methods brought and
their longer-term physical and psychological impacts —
including musculoskeletal pain, headaches, and weakAccording to Major General George Fay’s report, systematic use of
forced nakedness to humiliate detainees “likely contributed to an
escalating “de-humanization” of the detainees and set the stage
for additional and more severe abuses to occur.” MG George R. Fay
& LTG Anthony R. Jones, U.S. Army, AR 15-6 Investigation of Intelligence
Activities At Abu Ghraib Prison and 205th Military Intelligence Brigade
10 (2004), available at http://www4.army.mil/ocpa/reports/ar15-6/
AR15-6.pdf [hereinafter Fay Report].

18  

1 2   B roken L aws , B roken L ives

ness and numbness related to injuries, post-traumatic
stress disorder, major depression, anxiety, and sexual
dysfunction. Some former detainees also experienced
upon release a dramatic increase in alcohol consumption,
difficulty in maintaining family relations, loss of employment,
and the effect of perceived negative social status.
The relatively small, non-random sample of former
detainees evaluated does not allow this report alone to
support a generalized conclusion about the treatment
of all detainees in US custody. Yet the patterns of abuse
PHR found are consistent with numerous documents
released by the Department of Defense and reports by
the US government, independent organizations and the
media,19 making it reasonable to conclude that these
eleven detainees were far from the only ones subjected
to torture and ill-treatment, but rather add to the body
of evidence of widespread and systematic violations of
human rights.
They call out for investigation, accountability, and
redress. 

19 

See supra note 6.

II. Methods

P

HR conducted in-depth medical and psychological evaluations with a group of eleven individuals
formerly held in the custody of the US military
in Afghanistan, Iraq, and Guantánamo Bay, Cuba. The
assessments were conducted in accordance with the
guidelines for collecting physical and psychological
evidence of torture outlined in the Istanbul Protocol.20

Identification of Study Population
PHR sought to identify former detainees through a variety
of sources including human rights organizations, lawyers
representing detainees, support organizations, and direct
contact with former detainees themselves. The criteria for
inclusion of detainees were: the former detainee’s presence in US custody for some period following September
2001; PHR’s ability to evaluate the detainee in a setting
where his safety could be assured; the former detainee’s
residence in a place where the person’s safety could be
reasonably assured post-evaluation; the possibility of
referral to rehabilitation services to former detainees in
need of them; and the individual’s willingness to agree to
a medical evaluation. Despite very extensive outreach,
PHR encountered numerous difficulties identifying individuals who were willing to discuss their experience in
US custody and to go through a medical evaluation. The
Center for Constitutional Rights (CCR) and the law firms
of Burke O’Neil, LLC and Akeel Valentine, PLC helped
Istanbul Protocol, supra note 7. The Protocol provides standards for
medical evaluations of allegations of torture. It was the product of
three years of analysis, research, and drafting undertaken by more
than seventy-five forensic doctors, physicians, psychologists, human
rights monitors, and lawyers representing forty organizations and
institutions from fifteen countries. The Protocol also sets forth
principles for effective investigations of torture and ill-treatment,
including the requirement that States ensure effective investigation and documentation of allegations of torture and ill-treatment
committed under its authority such as granting access to evaluations by impartial medical or other experts. Id. at Annex I. The
UN Commission on Human Rights has included these principles
in several torture prevention resolutions. See, e.g., Human Rights
and Forensic Science, C.H.R. res. 2000/32, U.N. ESCOR Comm’n of
Human Rights, 56th Sess., U.N. Doc. E/CN.4/RES/2000/32 (2000);
Torture and Other Cruel, Inhuman or Degrading Treatment or
Punishment, C.H.R. res. 2000/43, U.N. ESCOR Comm’n of Human
Rights, 56th Sess., U.N. Doc. E/CN.4/RES/2000/43 (2000).

20  

PHR to identify the eleven individuals evaluated in this
report. Burke O’Neil, LLC, Akeel Valentine, PLC, and
CCR are representing former Iraqi former detainees in
legal claims against CACI International Inc and Titan
Corporation, private security contractors that operated
in US prisons in Iraq. The Center for Constitutional Rights
has coordinated much of the representation of prisoners
in Guantánamo, including in habeas corpus petitions challenging the detention of those imprisoned, as well as
legal and advocacy actions on behalf of those released.
PHR conducted evaluations in two different European
countries between December 2006 and September 2007.

Evaluators
Each evaluation team consisted of two experts, a physician and either a psychiatrist or a psychologist. The
evaluators all had substantial experience in medical
and/or psychological documentation of allegations of
torture. The team of evaluators were Sondra Crosby, MD,
Boston Center for Refugee Health and Human Rights;
Allen Keller, MD, Bellevue/NYU Program for Survivors of
Torture; Leanh Nguyen, PhD, Bellevue/NYU Program for
Survivors of Torture; Onder Ozkalipci, MD, International
Rehabilitation Council for Torture Victims; Christian
Pross, MD, Berlin Center for the Treatment of Torture
Victims; and Barry Rosenfeld, PhD, Fordham University.
In addition to providing their findings for this report, the
evaluators also serve as experts to lawyers.

Medical Evaluations in Accordance
with the Istanbul Protocol
The Istanbul Protocol consists of detailed guidelines for
the effective investigation and documentation of torture
and ill-treatment. It has been adopted by the United
Nations as the “gold standard” for legal investigations
and medical documentation of torture and ill-treatment
and is applied routinely in a variety of medico-legal
contexts. The medical documentation component of
the Istanbul Protocol involves a comprehensive clinical
assessment of physical and psychological evidence and
correlation of specific physical and psychological findings
  13

with individual allegations of abuse. The Istanbul Protocol
states that interpretations of physical evidence should:
A.	 Correlate the degree of consistency between the
history of acute and chronic physical symptoms and
disabilities with allegations of abuse.
B.	Correlate the degree of consistency between physical examination findings and allegations of abuse.
(Note: The absence of physical findings does not
exclude the possibility that torture or ill-treatment
was inflicted.)
C.	 Correlate the degree of consistency between examination findings of the individual with knowledge of
torture methods and their common after-effects used
in a particular region.21

possibility of torture and ill-treatment. The clinician’s
conclusions should take into account all sources of
relevant evidence (physical and psychological findings,
historical information, photographic findings, diagnostic
test results, and knowledge of regional practices) gathered in the medical evaluation as well as documentation
of relevant regionally specific form of torture.23 The application of Istanbul Protocol guidelines provides clinical,
evidence-based conclusions that enable adjudicators and
other legal experts to assess allegations of torture and
ill-treatment.
In accord with the Istanbul Protocol, the evaluators
prepared written reports for each individual evaluated,
including the following:

A.	 Correlate the degree of consistency between the
psychological findings and the report of alleged torture.

1.	 Case information, including the name of the subject
and the name and affiliation of those present at the
examination; the exact time and date, location, nature,
and address of the institution where the examination
was conducted; and the circumstances of the subject
at the time of the examination;

B.	Provide an assessment of whether the psychological findings are expected or typical reactions to
extreme stress within the cultural and social context of
the individual.

2.	 Background information of the subject including
general demographic information, past medical and
psychological history, review of prior medical evaluation of torture and ill-treatment;

C.	 Indicate the status of the individual in the fluctuating
course of trauma-related mental disorders over time
(i.e., what is the time-frame in relation to the torture
events and where in the course of recovery is the individual, and other related questions).

3.	 A detailed record of the subject’s allegations of torture
and ill-treatment as given during the interview,
including alleged methods of torture or ill-treatment,
the time when torture or ill-treatment was alleged
to have occurred and all complaints of physical and
psychological symptoms;

According to the Protocol, interpretation of psychological evidence of torture and ill-treatment should:

D.	Identify any coexisting stressors affecting the individual (e.g., ongoing persecution, forced migration,
exile, loss of family and social role) and the impact
these may have on the individual.

4.	 Physical symptoms and disabilities, where the development of acute and chronic symptoms and disabilities and
the subsequent healing processes is documented;

E.	 Mention physical conditions that may contribute
to the clinical assessment, especially with regard to
possible evidence of head injury sustained during
torture or detention.22

5.	 Physical examination;

Such clinical correlation of individual allegations of
torture and specific physical and psychological evidence
are generally described using subjective terms to indicate various levels of consistency, i.e., inconsistent,
consistent, highly consistent, virtually diagnostic, or
similar terms. These subjective descriptions convey the
opinion of qualified, experienced clinicians and serve as
the basis for the clinician’s conclusions regarding the

8.	 An interpretation of findings as to the probable relationship of the physical and psychological findings to
possible torture or ill-treatment; and

21 

Istanbul Protocol, supra note 7, at 72 (Annex IV).

22 

Id.

1 4   B roken L aws , B roken L ives

6.	 Psychological history and examination;
7.	 Diagnostic test results;

9.	 Conclusions and analysis of medical findings.
The interviews were conducted in the primary language
of each individual with the assistance of professional interpreters. The evaluations were all conducted in a confidential manner.
23 

Id.

Source of Information for
Medical Evaluations
Sources of information for the medico-legal reports
included: the clinical interview, psychological testing,
physical examinations, and medical diagnostics tests.
Psychological tests were administered to all former
detainees evaluated and included the Beck Depression
Inventory, the Harvard Trauma Questionnaire, and the
Brief Symptom Inventory and the Dot Counting Test (a
clinician-administered test of symptom exaggeration).24
The self-report psychological tests had been translated previously into the subject’s first language. Where
possible, the clinical examination included appropriate
medical diagnostic tests. Medical diagnostic tests were
administered to seven individuals and included bone
scans (six cases), an electrocardiogram (one case), a
troponin test (one case), radiographic tests (two cases),
and a blood test for Prostate Specific Antigen.
In one case, a forensic evaluation report conducted
in 2004 by representatives of a center affiliated with
the International Rehabilitation Council for Torture
Victims was available for corroboration with PHR findings. Similarly, the Guantánamo Bay medical record was
available in respect of another individual and was used
for corroboration purposes.
All the medical evaluations were subjected to an
extensive peer review process by PHR’s qualified
and experienced clinicians. The findings and conclusions of the medical reports are exclusively those of
the evaluators.
This report contains condensed versions of the
medico-legal evaluation reports, but no relevant findings
were omitted in the summaries. To protect the privacy
and anonymity of participants in the PHR investigation,
the individuals’ actual names and other identifiable characteristics have not been included in the report.

Human Subjects Protection
An independent PHR ethics review board (ERB) was
established for this investigation. The ERB consisted
of five individuals with expertise in clinical medicine,
public health, bioethics, and international human rights
law who reviewed and approved the investigation plan.
In reviewing the investigation procedures, the ERB was
guided by the relevant process provisions of Title 45 of
the US Code of Federal Regulations and complied with
the Declaration of Helsinki, as revised in 2000.25
PHR limited case selection of former detainees to
individuals who are currently eighteen years of age or
older. The evaluation team obtained both oral and written
consent from the individuals. Consent forms were translated into each subject’s first language. Additional oral
consent was obtained for access to individual medical
records. No former detainee who was eligible and
consented to an evaluation was excluded.
PHR made every effort to ensure protection and
confidentiality and to reduce any potential adverse
consequence to subjects for having participated in the
evaluations. Evaluations were conducted in the most
private setting available. Efforts were made to ensure
that the assessments were conducted in a culturally
sensitive manner. Participants did not receive any material compensation for participating in the evaluations and
were informed of this in the consent process.
Former detainees face some risk in being evaluated,
including continued harassment by the government in
their country of return, social stigma and humiliation,
and the risk of re-traumatization. The evaluators took
measures to minimize these risks by consulting with
individual participants or their legal representatives
regarding such possibilities. As needed and where available, the evaluators made referrals to local treatment
centers for survivors of torture or other physical and
mental health services.

Limitations
The Dot Counting Test is a brief instrument that assesses test-taking
effort in individuals ages seventeen and older. This test is designed
to detect lack of effort on cognitive measures, whether it is intentional (malingering) or unintentional (unconscious). The Dot Counting
Test measures an “overlearned” skill that is preserved in all but the
most severe brain injuries. Therefore a poor performance on the
test suggests lack of effort. This test is highly useful in any setting
where examinees have external incentives, such as personal injury
litigation, disability evaluations, and criminal cases, to fabricate or
exaggerate cognitive problems. Further, since this test assesses
exaggeration by counting the dots on a number of cards, it is most
likely least impacted by culture compared to language-based exaggeration tests. See Muriel D. Lezak, Neuropsychological Assessment (3d
ed. 1995).

24  

The non-random selection and the small number of
former detainees evaluated do not permit generalization of PHR’s findings to all detainees in US custody.
Nevertheless, the study provides critical insight into the
experiences of individuals formerly held in US custody in
Iraq, Afghanistan and Guantánamo Bay, Cuba during the
World Med. Ass’n, Declaration of Helsinki: Ethical Principles
for Medical Research Involving Human Subjects, World Medical
Association Doc. 17.C (1964, am. 1975, 1983, 1989, 1996, and 2000),
available at http://www.wma.net/e/policy/b3.htm.

25  

M ethods   1 5

period covered by the report. These accounts are consistent and add to the existing evidence on detainee abuse
detailed in other independent human rights organizations’ reports,26 International Committee of Red Cross
reports that have been made public,27 government investigations on allegations of detainee abuse,28 one prior
case report of medical evaluations conducted on two
former Abu Ghraib detainees,29 and the 2006 report of
five United Nations experts on the situation of detainees
at Guantánamo Bay.30
It is possible that allegations of torture and ill-treatment made by the former detainees were affected by
recall bias and/or intentional exaggeration or misrepresentation for personal and/or political gain. PHR could
not independently investigate and corroborate all statements made by the former detainees in this report, nor
assess the consistency of the detainees’ accounts. Due to
logistical and security reasons, PHR was unable to obtain
either 1) corroboration from any of the former detainee’s
family members concerning post-detention health and
functioning, or 2) prior medical records to determine
prior history. Where possible, PHR sought to corroborate
the former detainees’ allegations with external sources.
See, e.g., HINA SHAMSI, supra note 6; Amnesty International, supra
note 6; HRW No Blood, supra note 6.

26  

international committee of the red cross, report of the committee of the red

27  

cross (icrc) on the treatment by the coalition forces of prisoners of war and
other protected persons by the geneva conventions in iraq during arrest,
internment, and interrogation (2004), available at http://www.globalsecurity.org/military/library/report/2004/icrc_ report_iraq_feb2004.
htm [hereinafter icrc report].
28 

Schmidt Report, supra note 6; Taguba Report, supra note 6.

29 

Keller, supra note 6.

30 

UN Guantánamo Report, supra note 6.

1 6   B roken L aws , B roken L ives

The detention medical records of one individual and
the independent medical evaluation of another former
detainee were used to corroborate their accounts. Media
sources and released US government investigations on
allegations of detainee abuse were used to corroborate
accounts by two other former detainees.
In all cases, the evaluators made independent determinations of veracity and credibility as part of the evaluations, which they recorded in their reports. In each of
the medical evaluations, the physical and psychological
evidence was found to be consistent with torture and/
or ill-treatment. The evaluators used a number of
methods to ascertain the credibility of reported abuses
and resulting disabilities. These methods included a
comparison of self-report to objective medical evidence
(e.g., scarring and diagnostic test results) and analysis
of psychological test data (including a measure specifically designed to detect symptom exaggeration). In each
case, the clinicians, all of whom have extensive experience evaluating both torture survivors and/or individuals
involved in litigation, considered the individual evaluated
to be credible. There was no evidence of deliberate exaggeration in any case.

III. Medical Evidence of Ill-Treatment
in US Detention Facilities

T

he following summaries of the medical evaluations
of the eleven former detainees are presented in the
format of the original medico-legal evaluations and
with sufficient details to illustrate the evidence on which
the clinical evaluators based their conclusions regarding
torture and ill-treatment. The first seven profiles are of
Iraqi men who were detained at Abu Ghraib prison and,
in some cases, other facilities in Iraq. The following
four profiles are of men who were arrested in either
Afghanistan or Pakistan, detained at Kandahar, Bagram
or other locations in Afghanistan, and ultimately were
brought to Guantánamo Bay, Cuba. To protect the privacy
and anonymity of participants in the PHR investigation,
the individuals’ actual names and other identifiable characteristics have been omitted from the narratives.

P r o f i l e 1 : K amal 3 1
On September 21, 2003, Kamal was arrested in Baghdad
by US personnel and detained at Abu Ghraib prison. There
he endured beatings, sexual humiliation, and exposure to
temperature extremes. He was released from Abu Ghraib
prison in June 2004. In January 2005, Kamal was arrested
again by US personnel and was detained in several
different prisons over the next 21 months. During this
time he was not subject to any physical abuse; he was,
however, occasionally deprived of basic necessities such
as food, water, and access to toilets. The physical examination revealed several findings consistent with Kamal’s
allegations of the torture that he claimed to have experienced during his initial detention at Abu Ghraib. He now
suffers from major depressive episodes, a panic disorder
without agoraphobia (fear of public places or open areas),
and post-traumatic stress disorder (PTSD).
“They were spitting on me, and insulting me — holding
me from my beard. They were kicking me in my chest,
on my abdomen, and at one time they pulled me [up]
Kamal’s medical evaluation was conducted by Sondra
Crosby, MD and Barry Rosenfeld, PhD.

31  

the stairs and I have a scar on my leg [from it] … I had
a bag on my head, so sometimes they made me walk
into the wall, because I could not see anything.”

Background
Kamal, an Iraqi in his late forties, was raised in a relatively poor family. Despite having a disadvantaged start,
Kamal graduated with a degree in basic sciences. He
then attended military school, became an army officer
in the mid-1980s, and ultimately served in the military
for more than a decade. His duties included overseeing a
prison and later protecting oil fields in Kirkuk, but Kamal
never engaged in combat. He stated that he “escaped
from the military” in the mid-1990s because he was
asked to enroll in the Baath party. He recalled that the
authorities “tried to arrest me many times — because
of that I moved from one place to another…In the [mid1990s] they captured me once but I escaped through a
small window.”
In the mid-1980s, Kamal married and now has seven
children; the youngest one is four years old. Their lives
were difficult after his “escape” from the army, as
they were required to occasionally relocate, and were
concerned that Kamal would be detained by the Iraqi
authorities again. Kamal was initially quite happy when
the United States invaded Iraq, hoping that he would have
more freedom as a result.
After leaving the military Kamal supported his family
by selling goods in a small shop. He explained that he
was able to earn a sufficient income. After the American
occupation began, his community offered him the
honored position as the Imam of a local mosque. Kamal
described taking great pride in this position, although he
was ever fearful that he and his family would be arrested
by the authorities.

Allegations of Arrest and Abuse
According to Kamal, US personnel arrested him at
his home in Baghdad at approximately 2:00 A.M. on
September 21, 2003. “A very strong explosion took place
in my home. American soldiers had put bombs in front
17

of my door, and they exploded my home, the kitchen,
the car.” Kamal was then handcuffed and his head was
covered with a bag. American soldiers hit his family
members and “pulled [me] in a very bad way and started
hitting me in front of [my family].” Kamal recalled being
taken for a short ride in a humvee. Upon arrival at Abu
Ghraib, he was thrown to the ground and his head was
stepped on. This attack caused bleeding from his mouth
and eyebrow. He stated, “They broke one of my teeth,”
which later was extracted by a doctor in the tent area of
Abu Ghraib. Kamal noted that he lost consciousness and
eventually woke up in a cell block.
During his detention, Kamal described a range of illtreatment. He recalled initially being taken “directly to
a dark room” where he was stripped naked. The next
morning “they started questioning me and the torture
started… .They knew I was an Imam and they said I was
provoking people against Americans.” He stated that he
was kept naked in a cold, dark room for the first three
weeks at Abu Ghraib, and remained shackled throughout
much of this time. He explained: “They were spitting on
me, and insulting me — holding me from my beard. They
were kicking me in my chest, on my abdomen, and at one
time they pulled me on the stairs and I have a scar on my
leg [from it]… .I had a bag on my head, so sometimes
they made me walk into the wall, because I could not
see anything.”
Kamal described several assaults that caused painful
injuries. He described one incident in which he was struck
with a rifle in the head and right jaw while lying on the
ground. On another occasion, a soldier stabbed him in
the cheek with a screwdriver, causing intense pain and
bleeding. In one instance an interpreter kicked him in the
nose, causing bleeding. In one occasion, a soldier jumped
from a table onto his right thigh; in another incident a
soldier stamped on his right big toe, causing severe pain
that continues to this day. Kamal was also placed in “the
punishment room” several times, often for hours at a
time, and has subsequently developed rashes and “allergies…because there was urine there.”
Despite describing many physical beatings, Kamal
pointed out that “One of the most painful things, when
it got cold in November, they used to put my clothes in
the water and make me put them on, and get me into
my room without any blanket.” He was also subjected to
bombardment by extremely loud music for many hours,
which resulted in pain in his ears and bleeding. He
reported that he “heard the music after it was turned
off” and he continues to suffer from hearing loss as
a result.
1 8   B roken L aws , B roken L ives

Kamal stated that he was suspended in painful positions on approximately ten different occasions — often
elevated off the ground and for hours at a time. Kamal
described a particularly severe suspension:
[O]ne time they took me to be questioned and there
was a chain coming from the ceiling. It was a winch.
They pulled me [by my wrists, from behind] and they
left me for about four hours. Only my toes were
touching [the floor]. I started saying to them, “It is
very painful — I have a very severe headache,” and
after that I passed out.
He reported experiencing numbness in his right hand
for approximately one month following this suspension, and experienced pain in his shoulders and back but
noted that his pain has gradually decreased.
In addition to the many forms of physical ill-treatment Kamal described, he recalled numerous occasions of sexual humiliation. During interrogations, he
stated: “They intended to make me naked and show me
to everyone in the rooms, and humiliate me, and say,
‘This is the Imam of […].’ The same time, when they got
me naked, they used to bring all [the] female soldiers
to look at me and say ‘Hello, Imam’.” Kamal was photographed while naked, and US personnel threatened that
the pictures would be displayed in his home district.
Soldiers also touched his penis multiple times, causing
Kamal to feel humiliated and ashamed.
Kamal was shown pictures of a destroyed home and
was informed, “This is your home — we destroyed it.”
Kamal stated that he came to believe that his family was
also in the prison, and that they were being raped and
tortured. He said, “They were telling me, making me hear
voices of children and women, and told me they were my
children and [wife].” He also reported threats of prison
dogs being used to attack him.
Kamal estimated that he was interrogated on fifteen
different occasions. The interrogations were always
conducted by “civilians,” with the exception of one incident when he was interrogated by soldiers. When asked
how he could differentiate civilians from soldiers, Kamal
explained that he understood some English and was
often able to understand what the soldiers and civilians
were saying. He noted, “Some of the guards there did
not intend really to attack us — they were ordered by the
interrogators to attack us.”
According to Kamal, he remained in the isolation cell
for approximately two months, until November 2003. He
was then transferred to the tent area of the prison for
another seven months. Although he recalls no further

episodes of physical abuse, he described lasting problems as a result of the ill-treatment he suffered: “I told
the guards every day I had pain in my heart. They did not
do anything until after I had a heart attack. Then they
took me [to] the hospital.” Kamal was given medications
(Tylenol, Zocor, and aspirin) after he was returned to the
tents. Kamal also reported that he developed high blood
pressure in prison.
Kamal was released without charge from Abu Ghraib
prison in June 2004 and returned to his family. He
resumed making and selling goods, but became very
concerned that his wife and children were afraid of him.
He began living with his sibling and only visited his family
once each week because he believed his visits made
them uncomfortable.
In January 2005, Kamal was stopped by Iraqi police
and asked for identification. The police claimed that he
failed to obey them (an allegation he denied) and he was
turned over to American forces. According to Kamal, he
was detained in several different prisons over the next
twenty-one months but he did not report any beatings
during this time. He was occasionally kept in “lockdown,”
where he and the other prisoners would be kept “for
twenty-four hours without eating, without drinking,
[and] without going to the toilet.” He was also insulted
by soldiers and guards. He was released from prison for
the second time in October 2006.
Kamal was evaluated two months following his most
recent release from prison. At that time, he had not
yet resumed work. He explained, “When I got released
again…I was not concerned about [my business]. I was
a very ambitious man but I am not interested in that any
more.” He added that he continues to believe that his
family is afraid to be with him, and would like to take his
family out of Iraq but does not have sufficient resources
to do so.

Medical Evaluation

Assessment of Physical Evidence
The physical examination revealed several findings consistent with Kamal’s allegations of torture. His
appearance was noteworthy for a missing right upper
incisor. He has a lesion anterior to his right ear consistent with a healed cut from a sharp-edged instrument,
and an indentation before the left ear consistent with a
healed puncture injury, which is consistent with Kamal’s
description of being stabbed with a screwdriver in his
cheek by a soldier. Kamal also has a scar on the nose

consistent with a healed laceration resulting from being
kicked on the nose. The hyper-pigmented (i.e., darker
than the surrounding skin) flat lesion on his knee is
consistent with a healed laceration, such as Kamal’s
falling on a stair while being forced to walk shackled and
blindfolded. Further, a large area of palpable tenderness
on his right anterior thigh is consistent with the injury
caused by a soldier jumping on Kamal’s thigh. A lesion
on the right hand and the small hyper-pigmented, linear
lesion on the left ankle are consistent with scars from
shackles. The enlarged and irregular inter-phalangeal
joint on the left big toe is consistent with the injury he
described in which a soldier stepped on his toe, causing
significant pain. Kamal had physical evidence of nerve
injury, which can occur due to the suspension from his
arms that he described. Finally, there was evidence of
a prior jaw injury consistent with Kamal’s claim he was
struck with a rifle.
Medical Diagnostic Tests: Bone scan findings of
Kamal’s ankles are consistent with the repetitive blunt
trauma that often occurs when walking while shackled.
An electro-cardiogram revealed some nonspecific ST-T
wave changes, but no evidence of a prior myocardial
infarction (heart attack). A troponin test (blood test
that determines whether patient had a heart attack) was
also negative, which in the presence of Kamal’s report
of chest pain on the evening prior to this evaluation,
suggests that these episodes of chest pain are more
likely to be psychogenic (caused by the mind or emotions)
than cardiac in origin.

Assessment of Psychological Evidence
Kamal described himself as depressed and spontaneously articulated numerous depressive symptoms such
as feelings of guilt, worthlessness, and hopelessness. He
reported having lost interest in many of the activities that
he previously enjoyed, such as his work, and described
a lack of energy and a general feeling of sickness and
listlessness. He also reported a diminished appetite
and difficulty sleeping, including waking up frequently.
He reported frequent intrusive thoughts about the
sexual humiliation he experienced and noted that he
is unable to distract himself from these thoughts. He
reported frequent thoughts of revenge, but denied any
specific intent to harm others. He also denied suicidal
or homicidal ideations, and denied hallucinations or
bizarre, unrealistic beliefs (delusions), although his
perception that his family is afraid to be with him may
reflect paranoia.

M edical E vidence of I ll - T reatment in U S D etention F acilities   1 9

Psychological Tests:32 On the self-report measures administered, Kamal reported numerous symptoms of severe
depression, PTSD, anxiety, and disturbed thinking and
paranoid ideation.

Analysis and Conclusions
Kamal’s clinical presentation, reported history of abuse,
and the results of psychological testing support the
presence of several psychiatric diagnoses including
major depressive episodes, a panic disorder without
agoraphobia, and PTSD. Particularly striking is the
severity of Kamal’s depressive symptoms. Indeed, the
extent of Kamal’s depressive symptoms is suggestive
of an extremely severe depressive disorder that, in the
United States, would warrant psychiatric hospitalization.
In addition, Kamal described a number of symptoms
indicative of intense anxiety, including occasional panic
attacks characterized by chest pain (typically triggered by
thoughts about his past experiences and resulting anger)
accompanied by shortness of breath, tingling in his hands
and feet, and numbness. Although the latter symptoms
are confounded by Kamal’s report that he had a heart
attack while incarcerated at Abu Ghraib, his description of subsequent “attacks,” as well as the results of
electro-cardiographic and troponin testing, suggest that
his symptoms likely reflect a panic disorder rather than
a cardiac condition. This disorder likely emerged during
his incarceration, although a cardiac condition cannot be
excluded on the basis of this evaluation. Finally, Kamal
described numerous symptoms indicative of PTSD,
including intrusive thoughts and memories of the traumatic events (particularly the sexual humiliation), as
well as avoidance and emotional numbing behaviors
(e.g., anhedonia, feeling estranged from others), and
hyperarousal symptoms (e.g., sleep and concentration
difficulties, anger).
The results of the history and physical examination
also indicate that Kamal has persistent pain and physical
symptoms that he attributed to the injuries he sustained
during his arrest and detention at Abu Ghraib. Kamal
describes his physical health since release from Abu
Ghraib: “I always feel I am sick.” He described left arm
numbness, chronic headaches, and persistent pain in his
right thigh and right toe. He also reported hearing loss,
which he believes is from the loud music he was forced
to listen to in Abu Ghraib, as well as jaw pain, espePsychological testing included the Beck Depression Inventory, the
Harvard Trauma Questionnaire, and the Brief Symptom Inventory
and the Dot Counting Test (a clinician-administered test of symptom
exaggeration).

cially when he chews. Many of the specific pains Kamal
reported, and his description of the abuse that caused
these injuries, were supported by findings from the
physical examination. Although scarring is usually nonspecific in nature (i.e., the details of the injury cannot be
determined by the appearance of the scar), the observed
scars are all consistent with the injuries he described.
Other pains, however, such as chronic headaches, are
of unknown etiology, although chronic headaches may
occur as a result of head trauma. In addition, symptoms
may be psychological in nature (i.e., somatic), as many
individuals who have experienced severe trauma report
physical complaints that have no identifiable organic
basis. Other reported injuries, such as his complaint
of lasting hearing loss, could not be reliably evaluated
without additional testing (e.g., audiogram, evaluation
by an otolaryngologist) that was not available at the time
of this evaluation. However, his report of hearing loss is
consistent with the effects of exposure to loud noises. In
addition, his muscle weakness is consistent with nerve
damage from suspension.
Numerous indicators support the veracity in Kamal’s
report of the physical and psychological repercussions
from his ill-treatment. A test specifically designed to
detect psychological symptom exaggeration revealed no
such exaggeration and, in combination with the observed
consistency between the physical examination and his
description of physical ill-treatment and/or observable
scarring, supports his credibility.
In conclusion, based on the available evidence, Kamal
appears to have suffered severe and lasting physical and
psychological injuries as a result of his incarceration and
treatment at Abu Ghraib prison.

P r o f i l e 2 : H afez 3 3
On November 19, 2003, US soldiers raided Hafez’s house
in Baghdad and arrested him, detaining and interrogating him first at the Baghdad Airport and then at Abu
Ghraib prison over the course of seven months. Hafez
was subjected to stress positions, sexual abuse, sensory
deprivation, isolation, and sexual humiliation, among
other torture techniques. The physical examination
found persistent physical symptoms due to the injuries
he sustained in detention. Further, Hafez is suffering
from post-traumatic stress disorder as a result of his
arrest, incarceration, and related ill-treatment.

32  

2 0   B roken L aws , B roken L ives

Hafez’s medical evaluation was conducted by Sondra
Crosby, MD and Barry Rosenfeld, PhD.

33  

“[A]fter that they hanged me. There was some kind of
machine — a winch — that pulled me up [by my arms]
after each question…and because of this torture, I lost
consciousness two times…and when I lose [consciousness] they pour[ed] cold water on me and go on questioning me.”

Background
Hafez, an Iraqi man in his fifties, was born to a middleclass family. He completed two years of university but
withdrew from school before obtaining his Bachelor’s
degree because he needed to support his family. He
worked in a managerial capacity at a company for twenty
years preceding the American occupation. He stated that
this position allowed him to avoid mandatory military
service. Although the business at which Hafez worked
has been destroyed after the US-led invasion of Iraq,
Hafez explained that, “like other Iraqis,” he continues
to receive his salary.
Hafez is married with four children, the youngest
of whom is thirteen years old, and has two grandchildren, all of whom are living in the same household. He
attributed this living situation to “the bad circumstances
that we live in.” Hafez stated that he has never received
mental health treatment prior to or since his arrest and
incarceration. However, he noted that he felt a profound
“sadness” after his father and best friend were “killed
by the Americans” in the 1991 Gulf War. Despite feeling
depressed as a result of these losses, he was still able to
work and fulfill his family obligations, including helping
to provide for his deceased friend’s family.
Although Hafez described himself as generally healthy
prior to his incarceration, he noted that he was badly
injured during a 1998 bombing of the company where
he worked, which he attributed to the American military.
His injury required several surgeries and a few months
of hospitalization. He described suffering from chronic
lower leg pain, which required taking daily medication,
but stated that these problems have been stable for
several years.

Allegations of Arrest and Abuse
After midnight on November 19, 2003, US personnel
raided Hafez’s house in Baghdad and arrested him. He
stated that “my home was bombed…. Everything in my
home [was] broken — the doors, the windows, parts
of the walls.” The soldiers “were hitting everyone who
[stood] in front of them … One of the soldiers hit [my
wife] on the head with his gun.” He reported that his wife
currently suffers severe damage to her vision as a result

of this attack. He added that the soldiers stole all of the
money and valuables they had: “they took everything they
could find…and what remains…they destroyed.”
A plastic mask was then placed on Hafez’s face; he
was handcuffed and taken to the Baghdad airport where,
he stated, “My miserable life started.” He reported being
held and interrogated in a “small room” for approximately four to five hours. He stated he was questioned
about his political involvement and what he knew about
al-Qaeda. He remembered being forced down onto the
soil and being beaten severely on his legs and back by the
interrogating soldiers, which caused his lips, forehead,
and nose to bleed. He stated that he thought he would
lose consciousness. He reported having been stripped
and that his chest and pubic hair were ripped out by hand.
He added that, simultaneous to these abuses, “Others
were beating, hitting, and trying to choke me … [Also]
they were putting very cold water on me.”
In addition to repeated beatings, Hafez reported that
the soldiers pulled his penis and testicles, causing severe
pain. He recalled being threatened with a hammer and
was told, “We can break your head.” A soldier pushed
his hands into Hafez’s ribs very hard, causing severe
pain and shortness of breath. He stated, “After that they
hanged me. There was some kind of machine — a winch
— that pulled me up after each question…and because of
this torture, I lost consciousness two times… and when I
[lost consciousness] they pour[ed] cold water on me and
[went] on questioning me.” He noted that his shoulder was
dislocated as a result of being suspended. He also reported
losing feeling in his arms while being suspended, and
the numbness persisted for approximately three months
afterward. Hafez also described a sharp puncture to his
left foot that felt “like a needle.” He described the room as
severely cold and felt like “his heart stopped.”
Hafez recalled that during this initial interrogation,
someone who may have been a doctor examined him.
He stated that this individual “checked my heart and
blood pressure.” In addition, the doctor tried to put
his shoulder “back in its place” without providing him
with pain medication, a procedure that Hafez described
as “very painful.” He added that when the doctor had
finished treating him, “I heard the doctor say ‘continue’
[to the interrogators].”
After several hours of torture and interrogation at the
airport, Hafez said he was taken to Abu Ghraib prison.
When asked to describe his treatment at Abu Ghraib,
Hafez replied, “[At Abu Ghraib] the torture stopped, but
they started trying to affect me psychologically. I was in a
very dark and small room [measuring approximately 1.5

M edical E vidence of I ll - T reatment in U S D etention F acilities   2 1

by 2 meters] and I was totally [naked]. And the weather
was very, very cold — and you don’t have any blanket or
clothes to wear and I was sitting on the ground. And you
don’t know what is there on the ground and you don’t
know where you were, and there was very scary silence. The
only thing you can hear is the voices of those who have
been tortured at that time — screams and cries.”
During this time in isolation, he reported suffering
considerable pain from the previous physical abuse,
including frequent headaches, back and knee pains,
mouth pain, and trouble closing his mouth completely
because of a punch to the jaw. Hafez recalled that, due
to these injuries, he was unable to eat or drink for about
seventeen days. He acknowledged that because he was
kept in complete darkness and isolation, his only record
of time passing was based on listening to the prayer calls,
creating the possibility that he was confused as to the
amount of time he refused food and water.
Hafez recalled having been interrogated three times
while he was kept in the isolation cell at Abu Ghraib.
The first interrogation reportedly occurred after about
two weeks of his incarceration and lasted about thirteen
hours. He explained, “The interrogators asked me the
same questions, without hitting, but they were dealing
me very bad — insulting me, speaking in a bad way with
me.” He recalled that a Lebanese translator “asked the
interrogator to come out from the room and he started
offering to help me.” The “civilian” interpreter offered him
water, clothes, blankets and a bed if he cooperated, but
threatened that if he refused to assist them that he would
be taken to “Guantánamo — [where] you will never see
your family again.” Hafez recalled being given a blanket
and clothing after the end of the first interrogation.
Despite the reported ill-treatment and deprivation,
Hafez stated that he received medical attention shortly
after arriving at Abu Ghraib. “[The doctor] helped me …
he told the soldiers, ‘If you go on torturing him in this
way, he will die.’” Hafez recalled that the person whom
he perceived to be a doctor “tried to put [my arm] in
its place,” and “periodically came to me… [and] look[ed]
after my health.” On several occasions he was given
injections to his arms and a sublingual medication that
was helpful in relieving some of the pain he suffered.
After an estimated twenty-two days in isolation, Hafez
recalled being transferred to another part of the prison
for an additional thirteen days where, although he had no
further interrogation or ill-treatment, he felt threatened
since he did not have a prisoner identification number
and “expected to be killed.” He was subsequently transferred to the tent area of the prison.
2 2   B roken L aws , B roken L ives

Hafez remained in Abu Ghraib for a total of seven
months and was subsequently released without charge.
He reported suffering from many physical problems at
the time of his release including “a kind of swelling”
in his genitals. He attributed the swelling to both “the
torture” he had experienced and because he was forced
to wear “one suit [for] seven months,” which did not fit
well and was filthy. He reported experiencing “swelling”
in the anal area that required surgery.
Hafez reported that he sought medical and mental
health treatment following his release from prison,
including “heart doctors, and internal diseases doctor,”
and he received medication for “my broken bones…and
psychological medicine — Valium.” However he rarely
took the Valium since he was depressed and felt that the
medication increased his depression.
When speaking about his release, Hafez broke into
tears and described, “After I got out, I found my home
totally broken. I found my wife blind, and my children are
not good at their [schoolwork] any more. No one could
look after them well — no one helped them. They were
very poor, they were desperate. They even could not find
a door that could close the home — for three months our
home was open.” Hafez added that since being released,
he has relocated from his home.

Medical Evaluation

Assessment of Physical Evidence
The physical examination revealed several findings
consistent with Hafez’s allegations of torture, including:
two small lesions on the center and left of his forehead
that are consistent with blunt trauma to the head, as
he described occurring during his arrest; an asymmetrical left nasal bridge that is nonspecific but could
be due to blunt trauma to the nose; diffuse lower back
pain that is consistent with the history of beatings to
the back; a circular lesion on Hafez’s foot that is consistent with a puncture wound, as he described occurred
during his interrogation. Further, the medical examination revealed right shoulder pain to range of motion and
limited internal rotation that is consistent with a shoulder
injury resulting from suspension, as he described. The
scarring of Hafez’s anus is highly consistent with a prior
injury or surgery to the anus.
Medical Diagnostic Tests: Radiographic test results
(plain films of the nasal bones, right knee and right shoulder)
were unremarkable, with no evidence of fractures.

Assessment of Psychological Evidence
Hafez was calm and cooperative with the evaluation,
but became visibly upset (openly crying) when discussing

past experiences such as the death of his close friend.
He described himself as “depressed.” Hafez reported
feeling emotionally numb much of the time and thinking
about his experiences during imprisonment “constantly,”
referring to both the physical ill-treatment as well as the
losses his family has suffered. He reported continued
difficulty sleeping, noting that he re-experiences these
traumatic events both in his dreams and while awake.
He added that he has moved from his home “because
my home reminds me of what happened.” He described
avoiding thoughts and reminders of his incarceration
and only speaking about his experiences infrequently to
close friends. He reported fatigue, as well as problems
concentrating and thinking, diminishment in appetite
and sexual functioning, and decreased pleasure in daily
activities, in addition to general nervousness and anxiety.
He stated that he becomes particularly distressed when
he observes the American soldiers in Baghdad, although
he denied any specific fear of being re-arrested. He was
alert and oriented to person, place and time, and his
memory and concentration were grossly intact upon
formal examination.
Psychological Tests:34 On the self-reported psychological measures, Hafez demonstrated severe depression;
many symptoms of somatization (e.g., dizziness, nausea,
numbness); and many PTSD symptoms. He did not exhibit
symptoms of avoidance or emotional numbing. In sum,
findings from the self-report questionnaires indicated
the presence of considerable psychological distress
consistent with diagnoses of depression, PTSD, and
somatization disorders.

Analysis and Conclusions
Hafez’s clinical presentation, reported history of trauma,
and the results of the psychological testing support the
presence of several psychiatric diagnoses including a
major depressive episode, PTSD, and a probable somatization disorder. The last diagnosis, however, must be
considered tentative given the possibility that some or
many of his reported physical symptoms (e.g., persistent pain) may result from a genuine organic pathology.
However, other symptoms (e.g., persistent nausea,
frequent headaches, rashes) may well reflect underlying psychological distress suggestive of a somatization
disorder rather than a physical disorder.
Hafez described a number of symptoms indicaPsychological testing included the Beck Depression Inventory, the
Harvard Trauma Questionnaire, and the Brief Symptom Inventory
and the Dot Counting Test (a clinician-administered test of symptom
exaggeration).

34  

tive of the presence of a major depressive episode of
moderate severity. The depressive symptoms appear
directly related to the multiple traumatic experiences
he described. Although Hafez reported previous depressive feelings, particularly around the death of his father
and close friend in 1991, he denied having any significant
difficulty functioning at that time and described far more
severe symptoms at present. However, it is not possible
to conclusively determine the extent to which his depressive symptoms are the result of his arrest and incarceration experience versus the impact of other stressors
he described (e.g., his wife’s blindness due to head
trauma, his children’s increased behavioral problems,
his loss of income and deteriorated lifestyle). Hafez’s
reported PTSD symptoms, on the other hand, appear
clearly linked to his arrest, incarceration, and related
physical maltreatment.
The medical history and physical examination also
support Hafez’s report of persistent physical symptoms due to the injuries he sustained after his arrest
and initial interrogation. Hafez described chronic daily
headaches and diffuse musculoskeletal pain. In particular, he reported significant right shoulder pain and
functional impairment. Such chronic shoulder pain can
result from suspension from the arms and subsequent
injury to the joints, muscles, and ligaments. Likewise,
although many of Hafez’s scars are nonspecific (i.e., the
cause is not clear), they are consistent with the abuses
he described (i.e., blunt trauma to the head and nose,
and a puncture wound to his foot during his arrest
and interrogation).
Since his arrest and detention, Hafez also described
sexual dysfunction (“sexual ability [is] gone”), difficulty
breathing, and frequent rashes. Sexual dysfunction is
common in survivors of sexual trauma, and can be due
to both physical and psychological factors. Similarly, it
is not uncommon for people who have been traumatized
to have multiple physical complaints without an organic
basis (somatization). Although it was not possible to
determine whether some of Hafez’s symptoms (e.g.,
difficulty breathing, rashes) are organic versus psychological, they are all symptoms that are consistent with
traumatic experiences.
Although there is no way to determine the veracity
of Hafez’s report of torture and resulting physical
and psychological symptoms with absolute certainty,
numerous indicators support Hafez’s credibility. His
performance on a test specifically designed to detect
psychological symptom exaggeration in combination with
the observed consistency between the physical examina-

M edical E vidence of I ll - T reatment in U S D etention F acilities   2 3

tion and his description of physical ill-treatment as well
as his ready acknowledgement of prior traumatic experiences and physical consequences, strongly support the
credibility of his self-report. It is possible that Hafez’s
recollection of not drinking or eating for seventeen days in
Abu Ghraib was a product of the sensory deprivation, pain,
and confusion he experienced there rather than any deliberate desire to exaggerate the extent of his suffering.
In conclusion, the physical and psychological evidence
demonstrate that Hafez continues to suffer from considerable physical and psychological pain as a result of his
experiences during his arrest, incarceration, and interrogation while in US custody.

P r o f i l e 3 : L aith 3 5
Laith was arrested in October 2003 and was released
from Abu Ghraib in June 2004. During his imprisonment
he was subjected to sleep deprivation, electric shocks,
different forms of suspension, threats of sexual abuse
to himself and family members, and other forms of
abuse; the evaluators suspect that he was also subject to
sodomy. As a result of his arrest and incarceration, Laith
is currently suffering from lasting physical and psychological injuries including major depressive episode,
PTSD, and alcohol dependence.
I was in handcuffs and they poured the urine [into my
mouth] and sometimes I vomited from that but when
I vomited they kept on pouring [the urine] on my head
… I died at that time.”

Background
Laith is an Iraqi man in his mid-forties, who was born to
a poor family. He has three wives, two of whom remain in
Iraq and one who currently lives with him in another country.
He has several children from his first marriage.
Laith helped his father care for his younger siblings,
and also graduated from secondary school and university.
He joined the military soon after. He described his work
as extremely dangerous due to the state of continuous
conflict with Iran. He sustained multiple injuries during
his service and frequently feared that he would be killed.
For example, Laith described several gunshot wounds
sustained during different conflicts that have occurred
since the 1980s. He also reported incurring significant
shrapnel injuries when the car in which he was riding
Laith’s medical evaluation was conducted by Sondra
Crosby, MD and Barry Rosenfeld, PhD.

35  

2 4   B roken L aws , B roken L ives

was hit by an Iranian rocket in the mid-1990s. He stated
that this injury required prolonged hospitalization and
multiple surgeries. Despite these numerous injuries,
Laith expressed considerable pride in his accomplishments and described himself as a fierce fighter who
would give his life for his country.
Laith noted that he became increasingly frustrated
by unfair government policies, such as the execution
of citizens without just cause, and began speaking out
against these actions. He was eventually arrested by the
Iraqi government and sentenced to nearly two decades of
imprisonment, although he described this punishment as
comparatively lenient given Iraqi law. He was incarcerated for approximately eighteen months, during which
he reported being humiliated in interrogations. However,
he denied physical ill-treatment. He was released in
2002, when Saddam Hussein granted amnesty to prisoners in the hopes that they would help “defend Iraq.”
He noted that he joined the military, “I went to defend
[Iraq] strongly, and with braveness. And I do not regret
that, because I was not defending Saddam Hussein, I was
defending my country.”

Allegations of Arrest and Abuse
Laith was living in Baghdad with his second wife and
children when US soldiers arrested him at 1:40 A.M.
on October 19, 2003. His house was surrounded and he
recalled being surprised when the American soldiers
exploded the doors since he had turned on the light when
he saw the humvees arrive. He stated, “My wife and children started screaming; the glass [windows] was broken,
and they forced us to lie down on the [broken glass].”
He recalled that he was forced to walk on broken glass
and that glass shards became embedded in his feet,
remaining there for many months, including throughout
his incarceration at Abu Ghraib. Laith remembered that
he and his wife and children were all handcuffed behind
their backs, and the soldiers started kicking and beating
him with their guns. “I cannot remember all the details of
that night, but I remember that I was swimming in blood.”
Laith’s wife and children were also beaten. He believed
that the beating caused his wife, who was four months
pregnant at the time, to have a miscarriage. Soldiers
placed bags over the heads of Laith, his wife and children, removed them from their house, and “then they
exploded the home.”
Initially Laith recalled being taken to a home in
Baghdad where he was “question[ed] until the morning.
And they did torture to me — the torture was very, very
bad.” During that time, Laith reported being hooded,

having his hands and legs tied with chains, and being
in pain because of the cuts from the broken glass in his
feet. His Deshdasha (traditional floor-length white robe)
was removed, leaving him in his underwear. He reported
being kicked “whenever I had fainted or fell asleep.” He
was told that he should write his will because, one of the
interrogators said, “after two hours you will be executed.”
Throughout this preliminary interrogation, Laith recalled
bleeding from his nose, mouth and legs.
Laith was transferred to a second location, possibly
an airport. He could not ascertain the length of time that
elapsed or his actual location since he was continuously
hooded for about three days. He was detained inside “a
dark, closed room;” his hands and feet were tied; he
was dressed only in his underwear with a hood covering
his head; and he was periodically beaten and kicked.
He recalled that in one incident, “They took off even
my underwear. They asked me to do some movements
that make me look in a very bad way so they can take
photographs….They were trying to make me look like an
animal.” He stated that his genitals were touched “in a
very humiliating” manner and probed with a “stick with
electricity” and added that electric shocks were administered to his “private parts.” He described these shocks
as “painful, but not very much.”
Laith described his subsequent imprisonment at Abu
Ghraib as being “divided into two periods.” The first lasted
for approximately thirty-five to forty days, during which
time he was kept in isolation, in a dark cell approximately
1.5 by 2.5 meters in size. This room was “a cage, and inside
this cage there is another cage.” According to Laith, at
times he was forced to stay inside the smaller cage.
Laith’s brother was also imprisoned at Abu Ghraib, and
interrogators “wanted me to see my brother [being] humiliated like me…I saw his head bleeding …his hand broken …
He was naked ...with a piece of fabric covering his private
parts.” He added, “They were expecting me to lose all
my strength when I [saw my brother’s condition]…and
to further distress my brother…[to demonstrate] that the
Americans control everything.” Laith remembered being
punched when he tried to communicate with his brother.
While in isolation, Laith was interrogated for about
eight hours at a time and reported being beaten by fists
and kicked frequently. However he noted, “They were
not trying to [get] information…They were only trying to
humiliate me.” He recalled having been spit on and his
chest burned with a cigarette. He described one incident when his hands and legs were shackled and he
was thrown into a muddy puddle of water about ten
centimeters deep. He added that he was kept “naked

in these days [of isolation]…Only the last three days
they gave clothes.”
According to Laith, he was also suspended in the
cage and was forced to spend many hours with one arm
elevated and another tied to his ankle, or chained to a
bed with his arms and legs splayed apart. In another
stress position, his arms were suspended up behind him,
his feet were raised off the ground and he felt that his
“arms came out of place.” He occasionally fainted during
these suspensions, waking up on the ground. He recalled
that a medical person “put my arms back in place and
gave me [an] injection.” The suspensions “caused a lot
of pain” and Laith experienced numbness in his arms for
two to three hours after each session. He explained that
his hands were weak and he was “unable to hold even a
glass of water” after the suspensions. He estimated that
the “free suspension” (i.e., when he was elevated above
the ground by his arms) occurred “not less than four to
five times” but added, “If you ask me about being chained
to the window [standing], it was every day. They were
especially doing that at night, to prevent me from me
sleeping.” He added that dogs were brought to frighten
him while he was suspended, and he often received
scratches on his hands and arms but was not bitten.
Laith also described receiving hard slaps over his ears,
causing considerable pain, and being forced to dance with
loud music playing, resulting in ringing in his ears for
several weeks afterwards.
While Laith described these episodes as extremely
painful, he said the most “painful” experiences involved
threats to his family. He explained that “they were threatening me, saying they will bring [my] mother and sisters
[here] and . . . rape them. And they asked me, ‘Have you
ever heard voices of women in this prison?’ I answered
‘yes.’ They were saying, ‘Then you will hear your mothers
and sisters when we are raping them.’” He recalled
telling the soldiers, “Do whatever you want to me but
don’t touch my mother or sisters. They are women.” Laith
reported that he believed that the voices he heard were
his family members.
He also recalled having been forced to wear soiled
underwear, often for weeks or months at a time. “I had
diarrhea and I was in handcuffs. I was making my toilet in
my underwear and I was very dirty. That was very painful.”
He reported being denied medical attention for any of his
injuries. When he asked to see the doctor he was told
that “we brought a medicine to you.’” Laith explains that,
in fact, “They brought to me bottles [of] urine and [they]
told me if you do not drink these now we will bring your
mother and sisters. Because I was hearing the voices of

M edical E vidence of I ll - T reatment in U S D etention F acilities   2 5

women and children, I [believed him and] drank it. I was
in handcuffs and they poured the urine [into my mouth]
and sometimes I vomited from that but when I vomited
they kept on pouring [the urine] on my head … I died at
that time — after that I could not eat anything.” He said
that he was forced to drink urine from the soldiers on
eleven different occasions.
Laith described being threatened with sodomy on
several occasions but said he was not sodomized. He
recalled a soldier that “had a stick in his hand [that
he] was trying [hard] to insert in my [anus]…but I was
saying that I will kill myself if you do these things” and
screaming loudly “like crazy people,” which in his view
may have prevented him from being raped. He added that
the soldiers took many photographs of him in humiliating positions.
Laith reported that the second period of his imprisonment lasted for seven months, where he was kept in
an overcrowded tent with dozens of other prisoners. He
denied any further abuse during this time but described
being “punished as a group”, including incidents when
the detainees were forced to leave the tent to remain in
the cold without blankets and being refused permission
to go to the toilet to the point that “some of the prisoners
were peeing in their clothes.”
Laith was diagnosed with diabetes shortly before his
release from Abu Ghraib and is currently being treated
with medication. He was released from Abu Ghraib on
June 24, 2004 without charge. Laith immediately left
Iraq for another country, fearing re-arrest. After his
relocation, he described feeling “very, very nervous …
Sometimes I would hit the window, to break it.” He added,
“After I got out from the prison, I started drinking a lot —
every time I was always feeling that I want to get rid of
these pictures from the prison that I have in my mind…I
cannot sleep without alcohol or some Valium.”
Laith has been in another country for much of the
past two years, living with his third wife. He does not
have permanent residency in this country, and therefore
must leave the country every few months to re-validate
his visa. He noted that he spends most of his time alone,
drinks alcohol as much as possible, does not work, and
described himself as “a housewife” because of his
inability to support himself.

Medical Evaluation

Assessment of Physical Evidence
The physical examination revealed several findings
that are consistent with the musculoskeletal trauma
that Laith described during beatings at Abu Ghraib.
2 6   B roken L aws , B roken L ives

There is fullness and crepitation (a common finding in
osteoarthritis, which can be caused by trauma) at the
right lateral knee, which is consistent with trauma to the
knee, and diffuse musculoskeletal pain in the upper and
lower back and in both legs consistent with prior trauma
such as the repeated beatings Laith described having
sustained during his arrest and detention at Abu Ghraib.
The irregular lesion below the right tibial tuberosity and
the small round hyper-pigmented lesion above the right
medial malleolus (rounded protuberance on inside of
the ankle) are consistent with scarring from lacerations,
as Laith described having occurred during his beatings
while at Abu Ghraib. The scars on the right wrist, on the
dorsum of both hands, on the left hand, flexor surface
at the base of the left thumb, and on the right heel are
consistent with cutting wounds, which Laith described
as occurring when he was dragged and cut, possibly with
glass. Although Laith maintained that he was only threatened with sodomy, the physical examination revealed
scarring at both the inferior and superior poles of the
anus. These lesions are highly consistent with scars that
would result from attempted or actual penetration of
the anus with an object, as Laith described occurred to
others at Abu Ghraib. There is a two centimeter-wide
irregular flat area of slight hyper-pigmentation anterior
to the left ear that is consistent with a healed abrasion
that could have resulted from being dragged, which Laith
reported occurred at Abu Ghraib prison. There were no
visible cigarette burn scars on his chest, although it is
probable that this injury healed with scarring if the injury
was superficial. Examination also revealed multiple findings that were, based on Laith’s report, unrelated to his
arrest and incarceration at Abu Ghraib.
Medical Diagnostic Evidence: A bone scan revealed
uptake in the right mandible, in the medial right tibia,
and in both ankles and feet, which are findings consistent
with injuries sustained from walking when shackled for
a prolonged period. The findings in the right mandible
could be consistent with either blunt trauma or prior
dental infections. The findings regarding his medial right
tibia are consistent with prior trauma to the right knee.

Assessment of Psychological Evidence
Laith reported no previous history of psychiatric illness
and reported that prior to his detention in US custody he
drank alcohol only sporadically and in small quantities.
By contrast, Laith described himself as being extremely
angry and depressed most of the time after his release.
His affect during the evaluation was varied and appropriate to topic, smiling at times while at other times he

seemed on the verge of tears. He endorsed a number of
symptoms indicative of depression, anxiety, and PTSD,
including insomnia, diminished appetite, and concentration difficulties. He reported feelings of worthlessness
because of his inability to work and care for his family.
He denied thoughts of suicide, but expressed homicidal
ideation towards one of the men who had interrogated
him in prison. In addition to periodic nightmares, Laith
described frequent intrusive thoughts about the abuses
he experienced in Abu Ghraib prison and stated that,
although he tries to avoid thinking about these events,
he is unable to do so.
He stated that he feels upset whenever he sees
soldiers (“anything that relates to the military bothers me
and upsets me — uniforms [and] buildings bother me”)
and attempts to avoid places where he might encounter
soldiers. He added that he occasionally experiences
heart palpitations that he characterized as psychological
in nature and noted that he has frequent gastrointestinal
discomfort. He reported daily headaches and described
occasionally severe headaches that require analgesic
medication, as well as pain in other parts of his body that
he attributed to his prison experiences.
Psychological Tests:36 On the self-report measures
administered, Laith endorsed numerous symptoms
of depression, PTSD, and paranoia. His responses to
the Beck Depression Inventory (BDI) were indicative of
a severe level of depression, and were well above the
threshold typically used to identify a major depressive
episode. He also reported a number of vague somatic
symptoms (e.g., dizziness, nausea, numbness) that often
reflect psychological distress rather than physical illness
and that often occur in the context of PTSD.

Analysis and Conclusions
Laith’s clinical presentation, reported history of trauma,
and the results of psychological testing support the presence of several psychiatric diagnoses including major
depressive episode, PTSD, and alcohol dependence.
Laith’s symptoms support the presence of a major
depressive episode. In addition, Laith endorsed all three
elements of PTSD diagnosis, including frequent intrusive images, recollections, and nightmares, amnesia
with respect to periods of his traumatic experiences in
Abu Ghraib, and avoidance behavior. He displays severe
hyperarousal symptoms, such as irritability, sleep diffiPsychological testing included the Beck Depression Inventory, the
Harvard Trauma Questionnaire, and the Brief Symptom Inventory
and the Dot Counting Test (a clinician-administered test of symptom
exaggeration).

36  

culties, and hypervigilance. He also described occasional
chest pain (“a stab in his heart”) that he attributed to
psychological origin, but denied other symptoms of
panic disorder. Laith reported a dramatic increase in his
alcohol use, stating that he has been drinking alcohol on
a daily basis and feels irritable and uncomfortable,
with hand tremors and jitteriness, when he wakes in
the morning.
Laith’s report of multiple traumatic events prior to
his arrest and incarceration at Abu Ghraib complicates
assessment of the origin of these psychological symptoms. He acknowledged having been shot multiple times
while serving in the Iraqi army, and reported a prior
period of incarceration prior to US occupation. However,
the content of his intrusive memories and avoidance
behaviors focused primarily on his experiences at Abu
Ghraib, which suggests a clear link to his experiences at
Abu Ghraib prison. In addition, Laith adamantly denied
any prior periods of depression or PTSD symptoms, and
claimed that he previously drank alcohol only sporadically and in small quantities. Indeed, he stated that these
symptoms emerged only after his incarceration at Abu
Ghraib, suggesting that these experiences may have
caused the symptoms he revealed. In fact, while his prior
traumatic experiences may have left Laith more vulnerable to the subsequent traumas he described (which is a
common finding in the PTSD research literature), there
is no evidence that he suffered from significant psychological distress prior to this incarceration.
The results of the history and physical examination
support the conclusion that Laith has experienced persistent medical symptoms due to the injuries he sustained
during his arrest and detention at Abu Ghraib. Laith
described his physical health as “bad” since his release
from Abu Ghraib prison, and he reported chronic pain in
his neck, legs, right shoulder, and feet, all of which he
attributed to injuries sustained during his incarceration
(from beatings, suspension by his arms). He reported
chronic headaches, sometimes two or three times a day,
since his release from Abu Ghraib and denied suffering
from headaches prior to his imprisonment. He also
described constipation, occasional blood with his bowel
movements, sexual dysfunction, and feeling that his
stomach is upset and “full of gas” daily. Many of these
symptoms (chronic headaches, musculoskeletal pain,
chest pain, and abdominal pain) are common physical
sequelae of persons who have suffered multiple beatings to the head and body, suspensions, forced stress
positions, and sexual trauma. For example, chronic
shoulder pain can result from suspension from the arms

M edical E vidence of I ll - T reatment in U S D etention F acilities   2 7

and subsequent injury to the joints, muscles, and ligaments. Sexual dysfunction is also common in persons
who have experienced sexual trauma, and can be due
to both physical and psychological factors. In addition, it
is not uncommon for those who have been traumatized
to have multiple physical complaints without an organic
basis (whether due to somatization or other, psychological causes such as depression).
Although it is not possible to determine the injuries that caused Laith’s scars, the observed lesions and
reported injuries are consistent with the injuries that he
described. For example, his report of experiencing arm
numbness and weakness following the suspension by his
arms (“Palestinian suspension”) is highly consistent with
a brachial plexus (network of spinal nerves supporting the
arms and shoulders) injury that often results from this type
of suspension. Perhaps most important are the anal scars
that were observed. Not only are these scars highly consistent with anal trauma (i.e., as would result from forced
sodomy or penetration with an object), these scars are in
a location where accidental injuries would not occur. Thus,
these scars raise the possibility that, despite his denial of
anal penetration, Laith may have actually under-reported
the extent of the sexual trauma he experienced.
Numerous indicators support the veracity in Laith’s
report of ill-treatment and physical and psychological repercussions including (but not limited to) his
performance on a test specifically designed to detect
psychological symptom exaggeration. This finding, in
combination with the observed consistency between the
physical examination and his description of physical illtreatment, as well as his failure to endorse many psychological symptoms strongly support the credibility of his
self-report. In fact, the findings regarding possible sexual
trauma suggest that Laith may have actually diminished
the severity of trauma that he experienced, particularly
given his claim that he was not sodomized because of
his objections. In addition, Laith readily acknowledged
that many of the injuries he has suffered and multiple
traumatic experiences pre-dated (and were unrelated
to) his arrest and incarceration.
In conclusion, based on the available evidence, Laith
appears to have suffered severe and lasting physical
and psychological injuries as a result of his arrest and
incarceration at Abu Ghraib prison. His description of
acute symptoms (e.g., physical pain) during his arrest and
incarceration, as well as chronic physical and psychological symptoms since his release, is consistent with the
trauma he reported, and many are supported by observable
physical findings.
2 8   B roken L aws , B roken L ives

P r o f i l e 4 : Y asser 3 7
Yasser was arrested by the US military in Baghdad on
October 13, 2003. While held at Abu Ghraib prison Yasser
endured sexual assault, beatings, stress positions, longterm isolation, and electric shocks. He was released
from Abu Ghraib in February 2004. Medical findings are
consistent with Yasser’s allegations of electric shocks
and other traumatic experiences. He now suffers from
major depressive disorders and PTSD.
“I felt that my eyes would go out or blow, and I feel
my teeth, and one time I bit my tongue… When they
shock you with electricity it feels like your eyes will
explode.”

Background
Yasser is in his mid-forties and reported that his father
was a “simple farmer.” He was raised in a big family,
completed secondary school, attended an Islamic university, and eventually became a teacher. In the late 1990s,
he changed his career and became a farmer. According
to Yasser he was a respected member of the community;
people sought his help in resolving social disputes and
family problems and considered him a “wise man.” He
recalled many accomplishments during this period and
describes it as “the best days of our lives.”
Yasser noted that his only significant traumatic experience prior to his incarceration by the American military occurred in the early 1990s, when he was arrested
and detained for seven months by the Iraqi government
because he had joined a group that sought to “help the
poor people.” He explained that his incarceration was
“difficult…sometimes they hit us, punch[ed] us…but not
difficult after what we saw with the Americans.” Yasser
maintained that he does not suffer from any significant
or lasting problems resulting from this incarceration.
Yasser reported a severe injury to one of his upper
extremities for which he was hospitalized and had
surgeries. Yasser reported that due to his detention in
Abu Ghraib, he lost the opportunity to repair his injury
and now suffers permanent disfigurement and functional impairment.

Allegations of Arrest and Abuse
Yasser was arrested by the US military on October 13,
2003. He described being “surprised by two Hummers
and one tank” in the parking lot of the mosque he
Yasser’s medical evaluation was conducted by Sondra
Crosby, MD and Barry Rosenfeld, PhD.

37  

attended in Baghdad. He was handcuffed behind his
back, blindfolded with a hood, placed in one of the trucks,
and subsequently transferred into the tank. In the tank
the soldiers made him lie down and put their feet on his
back. Yasser then was taken to an “old military area”
in the El Amrea region of Baghdad and was detained in
“a garage for . . . vehicles, surrounded by the fences.”
He was transferred to Abu Ghraib on October 15, 2003.
According to Yasser, he was never informed of the reason
for his arrest.
Upon arrival at Abu Ghraib, Yasser recalled that he
was not forced to disrobe, although he felt “insulted” by
the US personnel as they “put their hands in my privates.”
He said he was forced to sit on the ground with other
detainees for four hours and then to crawl on the ground
with fellow detainees. Three people conducted the initial
interrogation, during which Yasser was commanded to
sit on the ground by an area near a putrid, dirty toilet. He
was asked whether he knew where Osama Bin Laden or
Saddam Hussein was. He was also asked about his injury
and was accused of “attacking the American forces.”
After this initial interrogation, Yasser recalled having
been blindfolded and taken in a truck to another area,
where he was kicked to the ground. Yasser stated he
was initially placed in the tented area of the prison for
about twenty-five days. He said he was interrogated once
during this period, when he was asked the same questions as before and was threatened with being sent to
Guantánamo, which the interrogator described as “a
place [where] even dogs won’t live.” He reported being
handcuffed to a ring in the ground, though he was not
physically harmed during this interrogation. Yasser
recalled that despite his repeated requests for medical
attention for his pre-incarceration injury, he was only
given one tablet daily for the pain.
Yasser remembered that he was transferred to another
section of Abu Ghraib just before the end of Ramadan. He
explained that he was handcuffed, had his face covered,
and was transported in a humvee with his feet tied to a
chain. When he arrived, he was told to “take off all [his]
clothes.” He followed the order but “kept the underwear
[on].” The US soldiers stripped him of his remaining
clothing. He subsequently had his face covered and was
handcuffed and chained at the feet. Yasser recalled,
“They started hitting and [told] me ‘Let’s go, let’s go’…
[W]hen they took off the cover… I found myself in a very
long hall. I used to hear some dogs barking and some
people shouting in a loud voice, in Arabic and English. I
walked for a few steps and there [were] stairs, and they
. . . hit me [and kicked me and told me] to go up… It was

very difficult to go up because of the chain, so I fell, and
I started to move on my knees and [used my chin] to go
up step by step….”
Yasser tearfully described that when he reached the
top of the steps “the party began…They started to put
the [muzzle] of the rifle [and] the wood from the broom
into [my anus]. They entered my privates from behind.”
He noted that several other soldiers and civilians were
present, including an interpreter with “a Lebanese
accent.” Yasser estimated that he was penetrated five
or six times during this initial sodomy incident and saw
blood “all over my feet” through a small hole in the hood
covering his eyes.
Yasser recalled that this “party” of abusive behavior
continued for approximately five days. In a particularly
traumatic experience, which Yasser describes as the
“music party,” he was forced to lie on the ground with
loudspeakers blasting music into his ears at a very painful
volume. He recalled that this lasted “about one day, but
you can say two years.” He reported having suffered from
the pain and resulting deafness for several hours afterwards and stated that he still feels upset whenever he
hears loud music.
According to Yasser, when he was finally returned to
his cell, he was denied clothing and a blanket for about
fifteen days, when the most abusive treatment stopped.
Other forms of abuse continued, such as being woken
up in the night and taken to a cold shower, where he was
again sodomized with a stick.
Yasser sobbed uncontrollably as he reported that he
was sodomized on about fifteen different occasions.
He felt severe pain and had difficulty defecating for
approximately three months afterwards. “I kept feeling
the wounds there — and it caused me a lot of pain.
Especially there —you can’t go to the toilet.” He added
that he received no medical care for these injuries, but
was occasionally given napkins and coffee grounds to
clean the wounds by “the man who takes the garbage — I
used to tell him it was for my hand wound because I was
shy about the injury.”
Many of the abusive incidents described by Yasser
occurred in the context of interrogations. In addition
to frequent, painful beatings, he reported suffering
extremely painful electrical shocks on three separate
occasions. “I felt that my eyes would go out or blow, and
I feel my teeth, and one time I bit my tongue… When
they shock you with electricity it feels like your eyes will
explode,” Yasser recalled. On one occasion, Yasser said
he passed out on the floor, and a doctor “opened my
mouth with his feet and poured the water in my mouth.

M edical E vidence of I ll - T reatment in U S D etention F acilities   2 9

Then he said ‘continue.’” During these electrical shocks
his eyes felt like they would “pop out,” his muscles shook,
and his teeth clenched. Further, Yasser reported having
burns on his thumbs, where round metal rings were
applied to administer the electric shock.
Yasser also recalled having been forced to assume
painful postures for extended periods of time. He
demonstrated by holding one arm to the floor with his
second arm raised above his head and explained, “They
tied one hand like this and one to the door of the cell —
and this is very uncomfortable.” This lasted for a whole
day, after which point the “position was changed to
another side.”
Yasser described a number of other abuses, including
having his already-injured hand deliberately stepped on
and squeezed by American soldiers. Further, soldiers
had written degrading phrases in permanent marker on
his head, in addition to other writings “all over my body
… and they sign[ed] their names on my body.”
Yasser stated that he remained in the isolation cell
for about fifty days before being transferred to the tent
area of the prison.
Yasser described another incident that, although not
physically painful, was extremely upsetting, particularly given his religious beliefs. Shortly after his
arrest, soldiers removed his egal (Arab headpiece)
and kicked it once it had fallen to the ground. He also
witnessed soldiers forcing Iraqi men to lie naked on
top of one another.
Yasser reported that he did not receive any medical
care while in the isolation cell. However, he stated,
“Doctors… used to be included with the questioning. …
Sometimes the dog[s] [bit] the prisoner, and [the doctor]
gives the needle to the female soldier for stitching — I
saw it.” When asked how he knew the individual was a
doctor, Yasser replied, “He had this bag… They call him
the doctor.” He added that the “two doctor[s]” usually
wore “an Army uniform, but sometimes they wore
civilian [clothing].”
Yasser was released from Abu Ghraib prison in
February 2004 without charge. He left Iraq shortly afterward out of fear of being re-arrested and to avoid frequent
painful reminders of his incarceration. Yasser described
a number of dramatic changes to his personality and
functioning since his imprisonment including a great deal
of anger towards the abusive soldiers, a general distrust
of Americans he encounters, and “a great sadness inside
me,” along with frequent nightmares about the abuses
that were inflicted during his incarceration.

3 0   B roken L aws , B roken L ives

Medical Evaluation
The traumatic experiences suffered by Yasser made it
extremely difficult for him to participate in the evaluation. He unexpectedly left the clinic to return to his hotel
without informing the evaluators on the first scheduled
examination date. He arrived promptly on the second
day, but appeared nervous and guarded, and chainsmoked cigarettes for the first two hours of the interview. He explained that he was chain-smoking because
“it hurts to talk about this.” As noted above, Yasser was
reduced to crying uncontrollably while discussing some
of the more traumatic experiences he suffered. He was
unwilling to fully disrobe for the physical examination,
and permitted only an extremely limited physical examination of his hands and tongue and a very brief external
rectal examination. Additionally, he declined the recommended medical testing (e.g., a bone scan). He explained
his reluctance by noting that, “Americans always want
us to undress.” It should be noted that, given his experience with the American soldiers, Yasser understandably
exhibited a high degree of distrust toward the American
clinicians and was on-guard in the beginning of the
evaluation. However, he became increasingly relaxed
as the interview progressed, occasionally smiling and
engaging in a more friendly exchange with the interpreter
and examiners.

Assessment of Physical Evidence
The results of the limited physical examination Yasser
permitted provide support for his allegations of the abuses
he reported, including evidence of scarring on his thumbs
that is consistent with his report of electric shocks. He
has two small areas of irregularities in the contour on
both his right and left sides of his tongue. These lesions
are nonspecific, but are consistent with biting the tongue,
as he reported occurred when the electric shocks were
administered. He has 0.5 and 1.0 cm hypo-pigmented
scars in the same location on both of his thumbs, consistent with scarring caused by electric shocks, of which
Yasser appeared genuinely unaware prior to the examination. Yasser allowed a very brief and limited external
rectal exam, and no lesions were observed; the exam
was incomplete, however, and thus inconclusive. There
is a deformity of his left hand with partial amputations
of the fourth and fifth digits and extensive scarring and
injury of the hand. Yasser attributed this injury to an
incident prior to his arrest and incarceration. However,
he stated that he has been unable to obtain medical
care for his injured hand since his release and reported
that he was informed that it was too late to repair the

damage because so much time had elapsed while he
was incarcerated.

Assessment of Psychological Evidence
Yasser described his mood as “sad,” and his affect
was clearly dysphoric, sobbing uncontrollably while
discussing some of the more traumatic experiences he
suffered. He reported numerous symptoms of depression
and anxiety, including frequent crying, intense anger,
diminished appetite, and weight loss. Although he denied
feelings of guilt or a lack of energy, he noted that he
has lost interest in everything except “my work” with
other torture survivors. He also described feelings of
worthlessness (“As a person [who] had the stick of the
brush put inside his body, what [do] you want him to
feel?”) and severe insomnia, with difficulty falling asleep
and staying asleep. He reported frequent nightmares in
which he relives his experiences in prison, as well as
intrusive memories of these events while awake (“How
can I forget this?”). Yasser noted that these incarceration
experiences have made him feel very “uncomfortable”
in his home region and added that he left Iraq in order
to avoid the frequent reminders of his imprisonment.
He stated that he also feels uncomfortable whenever he
sees policemen or Americans. Yasser reported difficulty
concentrating and no longer reads literature as he once
did. He also described periods of anxiety and occasionally becomes short of breath, but denied heart pounding
or palpitations, sweating, or other indicators of panic.
Yasser denied current suicidal ideations or intent, but
acknowledged that “Inside the jail, I did pray to Allah to
make me die.”
Psychological Tests:38 Yasser evidenced a number of
symptoms indicative of moderate levels of depression,
anxiety, PTSD, and paranoia, as well as physical symptoms likely indicative of a somatization disorder, all of
which warrant mental health treatment. Further, on a
clinician-administered test of symptom exaggeration,
Yasser’s performance indicated that he put forth considerable effort to respond honestly, with no evidence of
deliberate exaggeration. It should be noted that Yasser’s
responses to self-report measures were less pronounced
than suggested by his clinical presentation, raising the
possibility that he either lacks insight into the severity of
his emotional difficulties or is reluctant to acknowledge
the extent of the problems he experiences (i.e., defenPsychological testing included the Beck Depression Inventory, the
Harvard Trauma Questionnaire, and the Brief Symptom Inventory
and the Dot Counting Test (a clinician-administered test of symptom
exaggeration).

38  

siveness). Thus, interpretation of the test results offered
may underestimate the true extent of Yasser’s psychological difficulties.

Analysis and Conclusions
Yasser’s clinical presentation, reported symptoms, and
the results of psychological testing support a diagnosis of major depressive disorder and post-traumatic
stress disorder. Specifically since his incarceration,
Yasser reported difficulty concentrating. He also experiences periods of anxiety and occasionally becomes short
of breath.
Yasser described a number of symptoms of moderate
depression that have persisted since his imprisonment.
In addition, he revealed numerous PTSD symptoms that
have persisted for many months, including intrusive
thoughts and memories of the abuse he experienced in
Abu Ghraib, particularly sexual assault. Among other
things, Yasser suffers from avoidance symptoms, as well
as several hyperarousal symptoms. Moreover, the timing
of his reported symptoms (following his incarceration,
with no reported psychological difficulties prior to his
arrest) and nature of his intrusive memories and avoidance behaviors suggest that this period of incarceration,
and the sexual assault in particular, are likely to have
directly caused these psychological symptoms. It must be
noted that the severity of Yasser’s emotional difficulties
may be mitigated by his activities in support of survivors
of torture.
Perhaps most importantly, the available evidence
strongly supports the credibility of Yasser’s reported
symptoms and experiences. What is less clear is the
accuracy of Yasser’s report that his preexisting injuries
were significantly worsened during his incarceration. He
attributed the severity of his current disfigurement and
limited mobility to both direct, additional trauma (when
his pre-existing injury was deliberately exploited by a
soldier) and the indirect effect of preventing the surgery
he needed (and was reportedly scheduled at the time
of his arrest). However, without consultation from his
treating physician at the time of the injury and subsequent surgeries; it is not possible to ascertain the accuracy of his report.
The evidence of scarring on Yasser’s thumbs and his
description of the symptoms he experienced during
the shocks (the optical pressure and bodily convulsions) is highly consistent with reports of other individuals who have suffered such abuse and supports
the accuracy of his reported experience. Although his
refusal to permit a complete physical examination

M edical E vidence of I ll - T reatment in U S D etention F acilities   3 1

limits the degree of evidence available to corroborate
his reported sexual assault and sodomy, his description of rectal bleeding and the injuries he suffered
during these sexual assaults is highly consistent with
the typical effects of such abuse, as is his mistrust,
guarded demeanor, and inability to tolerate a physical
examination. In addition, Yasser revealed significant
psychological distress that appeared directly related to
his traumatic experiences during incarceration.

prior to his detention that included diabetes, a heart
attack, and an infection in his left toe, which was being
treated at the time of his arrest. He additionally reported
injuring his left hand in the mid-1960s during an accident, requiring surgery; an extensive, well-healed scar
on the left hand and a missing finger were noted during
the physical examination. Medications taken on a daily
basis at the time of his arrest included insulin, isordil
(usually used to treat angina) and aspirin.

Allegations of Arrest and Abuse
P r o f i l e 5 : M orad

39

Morad was arrested in September 2003 in Baghdad
and was detained for ten months, first in an Americancontrolled “camp” and then at Abu Ghraib prison.
Although subjected to far less physical abuse than other
detainees evaluated, Morad was subjected to various
forms of ill-treatment including humiliation, sensory
bombardment, sleep deprivation, isolation, and threats
to his family. An older man with health problems, Morad
by and large received proper medical care during his
period of detention, although his health deteriorated
significantly due to the his conditions of confinement. The
findings of his physical examination are highly consistent
with the events Morad described. Morad is experiencing
a mild level of psychological maladjustment that does
not reach a clinically significant level.
“It felt like being in a tunnel. I didn’t know when I
would get out. I couldn’t sleep very well. Thoughts of
my family, the future and the conditions of [my hometown]… I was afraid that they had been killed…. [It
wasn’t] clear that we were going to die, but we had
lost hope of being released.”

Background
Morad is in his late fifties and was born into a selfdescribed “rich family.” He completed high school and
worked for the government prior to his retirement in the
late 1980s. Morad reported that he was supporting his
family —a wife and six children, the youngest of whom
was ten years old—with a retirement pension and income
earned from a business selling supplies.
Morad described his life prior to his arrest in September
2003 as “happy” and reported that he was involved in
community activities. He denied any past trauma or
mental health problems. He reported a medical history
Morad’s medical evaluation was conducted by Allen Keller,
MD and Leanh Nguyen, PhD.

39  

3 2   B roken L aws , B roken L ives

Morad reported that he was arrested in early September
2003 in Baghdad and subsequently imprisoned for approximately ten months until early July 2004. He described
his arrest as follows: “I was at home, we were sleeping.
They came at dawn. All of a sudden, I just felt that the
Americans were standing over my head in my bed. I
was very embarrassed. They had broken into my house.
I asked them, ‘Why didn’t you just call me in? I would
have come in.’ But they were shouting and yelling, ‘No
talking!’” Morad reported that the Americans inspected
the house and separated the men from women. The men
sat on the ground while the women were ordered to stay
in the garden.
Morad described being taken out onto the street,
with his hands restrained with plastic cuffs. He recalled
noticing that about ten humvees had come into his residential area. He was hooded and put into one of the
humvees without being allowed to get his medications
to take with him.
He was taken to a nearby American-controlled “camp”
where he was kept in a large hall for several days. He
recalled that the prisoners were kept hooded and handcuffed in the back. They were also photographed. He
stated that although water was available, he was not
given food until the second day of his imprisonment. He
did not report any beatings while held at this facility,
although he recalled being “pushed and shoved around.”
In the approximately six days that Morad spent in the
large hall his hands were continuously tied, “even when
we went to the bathroom.” He described the bathroom
as “just an area in a garage. And we were constantly
watched by soldiers when we did our business.” He also
stated that he informed the authorities in that camp
on the first day about his medical problems, and they
provided him with insulin.
Morad reported being interrogated twice on the third
day of his imprisonment. He was accused of training the
resistance and of being a Baathist activist. According to
Morad, in another interrogation, an American major, “the

one who arrested me,” threatened to arrest his “beautiful
wife and daughter” and send them to “Gitmo” if he did
not “talk.”
Morad denied any physical ill-treatment during these
interrogations. However, he reported subsequently
asking for more medications, which were denied. “The
soldier said, ‘No more medicine.’ I think they said that as
if I [was] not cooperating with them.” Morad was uncertain about whether he received his medication on the day
after his interrogation.
He recalled being accused of being “a liar” and was
then taken to a former ranch of Saddam Hussein, where
he described being placed in solitary confinement for
nine to ten days. “Being in solitary was the worst,” noted
Morad, “There was nothing in the cell. I was watched
when I went to the bathroom, with the gun pointed at
me….They refused to give me the soap that I asked for
to wash myself.”
Prior to his arrest, Morad had been afflicted with an
infection in his left big toe. He described that, as a direct
result of the unsanitary conditions during his arrest and
detention, the infection worsened. This condition was
finally attended to, following the intervention of a soldier
who called a doctor for him. The doctor treated Morad
by cleaning his infected toe, administering antibiotics,
insisting that his hands (which had remained cuffed in
front of him for four to five days and had began to bleed
at the wrist) be untied, and providing him with insulin.
Morad noted that the doctor kept his daily doses of insulin
fresh by keeping it on ice. Morad remarked that that he
had received “humane treatment” from that doctor.
In contrast, he remembered being sleep-deprived
during that period of his detention. “They played very
loud music in the hallway. It was deafening. No sleep was
possible.” He also recalled being subjected to another
interrogation, where he was forced to “sit in the bathroom.” He described that he was not allowed to kneel—
which he felt would have been more comfortable—but
was instead made to squat on the toilet. The interrogation
was aided by a Lebanese interpreter, who said, “You will
die here.”
After that period of detention at the ranch, Morad
was hooded, handcuffed, and transported to a “military
building at the airport.” He reported feeling disoriented
and confused about the reasons for, and location of, his
transfer. He remembered being worried about being
transferred to Guantánamo. When inside the building,
he was given a red uniform and put in a room with three
or four other men. He recalled, “It was like hell there.
I began to see what humiliation means, in that place.

American soldiers would bang loudly on the door. They
forced us to face the wall with our hands raised. They
called us by number, not by name.”
Morad recalled one interrogation that was conducted
by a Korean-American soldier assisted by an interpreter
who was an Iraqi Christian. He described the soldier as
“polite” and the interpreter as “a very polite older man.”
During that interrogation, he was questioned about the
reasons for Iraqi resistance, the difference between
American and British occupation (as experienced from
his Iraqi perspective), and information about Iraqi tribes
in his hometown. According to Morad, he was “very frank”
and forthcoming with explanations about Iraqi culture
and with information about the customary activities in
his region. He noted that “there was no appreciation”
but he was assured that he would be released as soon
as he was found “innocent.”
After nine days, Morad’s prisoner number was called
and he was transported in a truck with his hands tied.
He believed that he was being released but, upon arrival,
he was roughly dragged down from the vehicle by an
American soldier and was told that he had arrived at
Abu Ghraib. For most of the time he was imprisoned
at Abu Ghraib, he was held in a tent where prisoners
were not allowed to have visits from family members. “I
was out of the world, no news, no radio, nothing to link
me with the outside world. No contact with my family
for them to know if I was alive or dead.” Morad was not
questioned at all during the months he was held in the
communal tent.
Morad described inspections, on one or two occasions,
by “the riot police.” He recalled, “This happened in the
winter on a cold night… We were outside for almost one
hour, sitting down on the ground… And the soldiers would
enter the tent, inspecting everything and throwing things
down, and then after it would take us several days to find
our things. They would take many of the blankets and
leave us with only three each and it was very cold….”
On another occasion, during warmer weather, Morad
described a punishment he was given: “I saw another
prisoner returning from the bath, and I said to myself, ‘Oh
I recognize him.’ But the American soldier thought I was
speaking to him…He came and handcuffed me and took
me outside and made me sit on the ground for an hour.”
Approximately four to five months into his imprisonment Morad developed a new infection, this time on his
right foot. He attributed the progression of the infections
on his feet to the prison conditions: “[D]uring the summer
it was very hot in the tents. In the winter it was very cold,
for the first seven months, approximately. The floor was

M edical E vidence of I ll - T reatment in U S D etention F acilities   3 3

the bare ground-dirt and was not smooth…. While I was
imprisoned, I wore the slippers that I wore at the time I
was arrested. They gave me a boot in prison that was too
small. I told them many times it was too small, but they
did not replace [it] with a larger one even though they
knew I was a diabetic. When I would stay in my bed, it
was okay for me. But when I would get out of bed, my foot
would get dirty, and I would bang my foot more because
the ground was not smooth. At that time I began to use
[a] cane because my feet were hurting.”
Morad reported that he had asked to see a doctor
about his leg “more than ten times,” but only limited care
for his infection was provided. He recalled that a doctor
would come to the tent and give him “simple treatment.”
He did, however, receive his medications on a daily basis
from a nurse.
Morad described a particularly significant episode in
relation to his medical care. He recalled that the infections in his feet had worsened to the point where he
could not stand. An ICRC representative visited him and
then intervened on his behalf, telling him that he “must
be hospitalized either today or tomorrow.” Morad was
transferred to the Abu Ghraib infirmary, where he was
attended by an American doctor whom he described as
“a nice guy.” Soon after, he was taken by helicopter to a
hospital in the “Green Zone.”
In that hospital, Morad reported that the surgeon who
examined him declared that his foot had to be amputated.
Morad, who understands basic English, protested and
refused the procedure. Morad believed that, had he not
understood English, the doctors would have proceeded
with the amputation. He reported the following, “The
doctor said, ‘Why no cutting? This is my decision.’ I
insisted, ‘No this is my decision.’”
After he refused the surgical procedure, Morad was
returned to Abu Ghraib. At the reception processing
center in Abu Ghraib, Morad described the following
incident: “The soldier told me to hold my hands up with
my face to the wall. I was standing for approximately ten
minutes and I was tired. I put my hands half down, and
the soldier kicked me on my right leg and I fell on the
ground. I think he knew that I was in the hospital; my
right leg was wrapped, and he could see that. He asked
me why I had lowered my hands. I told him I was very sick
and that I was in the hospital, and I began to cry at that
moment. So he brought me a bottle of water.”
He remained in Abu Ghraib’s infirmary for fifty days.
He recalled that an African-American surgeon from the
hospital in the Green Zone would visit him. Morad stated
that the doctor told him that his foot did not need to
3 4   B roken L aws , B roken L ives

be amputated. Morad was eventually returned to the
tent area of Abu Ghraib. He reported that although he
explained many times that he is a diabetic, he was nevertheless given the same food served to other prisoners.
Morad described the ill-treatment of another detainee
in his tent who could not walk very well and had to use
crutches. “The prisoner, he was around fifty-five to sixty
years old, told me that during an interrogation he was
thrown to the ground and lost consciousness. When
he opened his eyes he was in the hospital [with] a cast
on one of his legs. Later, at a time after his cast was
removed…[the military] took him outside the tent [for
interrogation] and made him stand outside next to the
guards for two hours, using his crutches. I heard him ask,
‘Why am I standing here?’ We could see him standing
with the guards, and he was told that the interrogation
was postponed, and then he was brought back in. It was
very cold outside. …. He looked very weak.”
Morad was allowed to see his family on three visits after
he was released from the infirmary of Abu Ghraib. “They
cried when they saw me. I had many changes. I had lost
weight, had bad eyesight, my knees were very weak. I had to
use a stick to walk.” Two months after he left the infirmary,
Morad was released from Abu Ghraib without charge.
After release from Abu Ghraib, Morad reported struggling with economic difficulties related to the loss in his
business. He described a quick rehabilitation into civilian
life, however, regaining his status in the community and
enjoying once again being the leader of his large family.
He noted that he received much sympathy from people
regarding his arrest and imprisonment.

Medical Evaluation

Reported Physical Symptoms
Morad reported that his eyesight had become much
worse and he felt much weaker compared to before his
imprisonment. He had lost weight, and he also described
continued problems with his feet. “When I left Abu Ghraib,
my feet were in very bad shape. There was discharge
from the left toe that smelled bad and the right foot had
a hole from the infection.” He described having difficulty walking after being released and stated that it took
approximately two years for the feet ulcers to improve
to their current state. He reported that the condition of
his feet has been stable for the past six months. He also
described experiencing some pain in his knees.

Assessment of Physical Evidence
Physical examination revealed that Morad has two
hypo-pigmented jagged scars, one on his left wrist

(measuring .8 cm long and .6 cm wide) and one on his right
wrist (measuring 1.5 cm long and 1 cm wide). He believed
these scars were from wounds from wearing plastic
shackles. Such marks are consistent with handcuffing.
On the lateral aspect of the left big toe, there are
marked hyper-keratotic changes (dried thickened skin)
with three fissures (linear cracks) forming a stellate (starshaped) with a black center. There is no discharge. On the
right side of his right heal there are marked hyper-keratotic changes, with cracking and thickening of the skin.
There is no discharge. These changes are consistent with
the history of foot ulcers that Morad described.
While Morad was observed to walk without a cane,
he was observed walking slowly and cautiously, with
some difficulty.

Assessment of Psychological Evidence
Morad presented an open, good-natured attitude. He
summarized his current attitude and condition in life as
“telling the truth and forgiving the past.” In recounting
his experience during the period of his imprisonment,
Morad emphasized the feelings of humiliation and indignation at the behavior of American soldiers, which was
disrespectful and lacked honor. He also remembered the
separation from his family as quite difficult. In particular, he described not knowing of their well-being and
not being able to communicate to them his condition as
painful and hard to tolerate. He remembered eventually
settling into the following state of mind, “It felt like being
in a tunnel. I didn’t know when I would get out. I couldn’t
sleep very well. Thoughts of my family, the future, and
the conditions of [my hometown]… I was afraid that they
had been killed…. [It wasn’t] clear that we were going to
die, but we had lost hope of being released.”
Morad confirmed feeling “stressed” and “bothered” by
“a few bad things”: the American occupation of Iraq, the
losses that his family had to endure, the compromised
living conditions because of the war, and his experience
of being mistreated and disrespected.
Morad described how memories and thoughts of prison
caused “feverish feelings in my body.” He confirmed still
having occasional flashbacks of his arrest and imprisonment in Abu Ghraib. In particular, he still has some
intrusive thoughts and recurrent memories of American
soldiers standing over his bed during his arrest.
Psychological Tests:40 Morad declined to complete
several standardized tests. His responses on the stanBrief Symptom Inventory (BSI) measures various indices of psychological dysfunction such as somatization, phobic anxiety and
depression.

40  

dardized structured brief symptom inventory showed
insignificant symptoms. The only items he endorsed that
reached any degree of significance indicated a fear of
being exploited, harmed, or betrayed by people.

Analysis and Conclusions
The findings on physical examination, particularly of
Morad’s feet, are highly consistent with the events Morad
described. It is likely that the stress from Morad’s imprisonment and the conditions he described facing while in
prison, including being held in a tent with a dirt floor,
being forced to sit outside in the cold on a muddy ground,
and not having adequate footwear, contributed to the
worsening of the foot ulcer on his left big toe and the
development of the right foot ulcer he described. While
records of his medical care in Abu Ghraib were not available for review, it appeared that he received medical care
from which he clearly benefited. However, it is possible
that his foot ulcers were not adequately monitored or
treated earlier in his imprisonment, to prevent their
progression to the point of requiring hospitalization and
nearly amputation of his feet.
Although Morad still has difficulty walking, he reported that
he currently walks without a cane. It is likely that the
residual scarring from his foot ulcers impacts his ability to
walk to some degree. Given his underlying medical conditions, particularly his diabetes, Morad’s imprisonment
and the conditions of his confinement likely contributed
substantially to his presentation of foot ulcers and wounds.
Morad’s self-reports of his daily functioning, his
responses on the BSI standardized test, and the clinician’s behavioral observations and mental status examination during the evaluation suggest the picture of an
individual who is experiencing a mild level of psychological maladjustment. Morad’s emotional distress is
connected to both his past experience in prison and the
current stressful conditions of living in an occupied and
war-torn region. However, his distress does not reach a
clinically significant level and does not seem to impair
his functioning.
Based on the manner in which Morad described his
imprisonment (both in content and in style), as well as
the clinical findings from the physical and psychological
examinations, the clinicians had high confidence in his
credibility. He was forthcoming in the history he provided
about what he did and did not remember, when he was
and was not treated well, and which scars, notably on his
left hand, were unrelated to his imprisonment.
Morad still experiences some psychological symptoms, including occasional disturbing memories, relating

M edical E vidence of I ll - T reatment in U S D etention F acilities   3 5

to his arrest and imprisonment. However, the lack of
psychological impairments (as defined in stringent
clinical terms) is likely a function of both his coping
resources and the nature of his trauma experiences,
which inflicted fear and humiliation but did not include
elements of extreme violation or mortal threats.

P r o f i l e 6 : R ahman 4 1
Rahman was imprisoned beginning in October 2003 at
Abu Ghraib prison for approximately nine months and was
eventually released in late May 2004. He was subjected
to beatings, temperature extremes, sexual humiliation,
isolation, and stress positions. The medical evaluation
found significant physical and psychological injuries that
are consistent with his reports of symptoms and trauma
history. He suffered from PTSD after his release from
prison and is currently experiencing avoidance symptoms and the clinical syndrome of shame.
“When they finished hitting me...they shaved my hair. The
only hair I had was in the middle. This was only to humiliate me. They just wanted to laugh. Then they took me to
the bath and opened the cold water and they pushed me
there, and they used to hold my arms, and push my head
under water, and sometimes to breathe, I was pushing
back and pulling my head out of the water.”

Background
Rahman is in his early forties. He completed three years
of university education. Prior to his arrest he owned his
own business. While life in Iraq was “not easy,” Rahman
described being generally happy. He also described
himself as ascribing to the religious teachings of Islam,
“I wished everybody a good life. I tried to practice love,
peace, altruism.”
Rahman stated that he did not have any physical or
mental health problems or traumatic experiences prior
to his imprisonment. He reported being summoned for
questioning in 1989 and 1994 by local authorities under
the regime of Saddam Hussein, a reportedly common
experience for shop owners to endure. However, Rahman
denied any ill-treatment during these meetings.

Allegations of Arrest and Abuse
Rahman was arrested at his shop in Baghdad in October
2003 by American and Estonian troops who handcuffed
Rahman’s medical evaluation was conducted by Allen
Keller, MD and Leanh Nguyen, PhD.

41  

3 6   B roken L aws , B roken L ives

his hands behind his back, arrested him, and searched
his shop. He was not beaten. He was taken to a US facility,
photographed, and questioned about various individuals
from his region. During that session, an officer accused
Rahman of attacking and killing Americans, which
Rahman denied.
Rahman was transferred the next day to Abu Ghraib
prison and was kept in a small tent. On the fifth day, he
reported being hooded with a bag and was taken to a
room with two female interrogators, an interpreter, and
a soldier. “My heart was beating so much and I was really
scared,” said Rahman. His clothes were forcibly removed
after he refused to remove them himself. In an attempt to
hide his genitals, Rahman knelt to the ground. During this
interrogation his hands were handcuffed behind his back.
Following this interrogation, Rahman was again hooded
with a bag and taken to a prison cell, where he was kept
naked for five to six days. He was interrogated several
times during this period, and was regularly kicked and
hit. Rahman reported that cold water was thrown on him
repeatedly and he was forced to stand the entire night
shackled while he was in his cell. Moreover, he described
how cold water was thrown on him and he was forced
to bathe in it: “I was very low and sitting in a corner in a
small position to relieve myself. And he [a guard] came
with a bucket of water and just threw it on me...The whole
night he was throwing water on me.” Rahman reported
that later that night he was forced to take a cold bath and
was then returned to his cell, where he was handcuffed
to his bed and kept standing all night.
Following the first few days in Abu Ghraib, Rahman was
kept in a dark, windowless, cold room, naked, for approximately fifty days. During this time, he reported the recurrent practice of being forced to stand naked and hooded
outside of his cell for several hours. In addition, Rahman’s
head was immersed in cold water on a daily basis.
Rahman developed a fear of his dark, windowless cell.
In one incident, while receiving medication, he pleaded to
a person whom he perceived to be a doctor for permission to remain on the outside of his cell. “I told him that I
couldn’t take it any more. The room didn’t have a light.” The
doctor transmitted his request but the soldiers refused.
Rahman said that remembering the claustrophobic conditions of his cell and his nakedness are the most difficult
parts of his experience to recall emotionally.
On one occasion in the small cell, he was beaten,
his hair was shaved, and he was immersed in water. He
reported, “When they finished hitting me...they shaved
my hair. The only hair I had was in the middle. This was
only to humiliate me. They just wanted to laugh. Then

they took me to the bath and opened the cold water
and they pushed me there, and they used to hold my
arms, and push my head under water, and sometimes
to breathe. I was pushing back and pulling my head out
of the water.”
Rahman was shown photographs of naked prisoners
by the soldiers. “You feel insulted, you feel humiliated.
It became kind of a joke with the soldiers. They were
showing the pictures and saying, ‘Which butt is yours?’”
On one occasion, Rahman stated that he was forced to
wear women’s undergarments. On several occasions
Rahman was confined for several hours in a small, cold,
dark, windowless cell that smelled of urine. He described
feeling the urge to urinate without being able to do so.
According to Rahman, beatings and kicking, cold-water
immersion, and unpredictable and arbitrary confinement
in the small, dark room occurred repeatedly. Occasionally,
while blindfolded, he was threatened with death.
Rahman reported that he tripped when soldiers
pushed him down the stairs, injuring his right foot. He
was pulled and yelled at to stand up: “I was crying and
screaming … I asked to see a doctor, but they told me
to ‘shut up’”. According to Rahman, when he asked one
soldier to look at his foot, the soldier hit him on the shoulders, kicked his legs, and then ordered him to stand by
the wall. Subsequently, he was tied to the bars in his
cell and was forced to stand until the morning. Rahman
reported that he was unable to bear weight on his right
foot for two months. When he was forced to stand, he
would lean against the bunk so as not to put weight on
that foot. His foot was swollen and black and blue, and
it took approximately a month and a half for the swelling
to subside. He was neither provided with medical care or
with crutches until he was transferred to the communal
tents, where he was able to use a stick to walk.
In another incident, Rahman recalled that he received
a severe, heavy blow to his head that caused him to lose
consciousness. He could not identify or remember the
object with which he was struck.
Rahman also reported that the food that he was given
was “barely enough” and was “really bad.” His food would
be tossed or kicked by the guards into his cell in a small
bag, and was sometimes thrown into or near the toilet.
Rahman did not recall being subjected to any illtreatment while he was kept in the communal tent area
of Abu Ghraib: “Life in the tent was simple. There were
not too many things to remember.” One detail, however,
stood out from that period: his fellow prisoners in the tent
section told him that, while in the individual-cell section
of Abu Ghraib, they had witnessed him being beaten, tied

up and pulled like a dog. This fact was troubling to him,
as Rahman had no recollection of that event. He had no
explanation for the discrepancy between his recall and
that of his fellow prisoners.
Initially Rahman denied adamantly that he himself was
threatened with or a victim of any direct sexual assault or
rape, but in a later interview he described one instance of
attempted rape. Late one night, a soldier approached him
in a threatening manner and asked if he was a bomber or
a terrorist. Rahman recalled the following, “He started
to go closer to me and said, ‘You are a bad man,’ and he
unzipped his pants and took out his penis. I had to defend
myself. I fought him off. This fight between us took a
minute. Three to four times I was on the ground and he
was pushing me back and I said ‘No! No! No!’”
Before his transfer to the communal tents, Rahman
recalled seeing naked prisoners forced into a position
where their genitals would touch each other and into
another position that simulated anal intercourse. He
reported seeing guards throw candies at the genitals of
naked prisoners. Rahman recalled other sexually humiliating practices, one involving a naked human pyramid.
On one occasion, he was ordered to watch naked men
being tied by the neck and forced to walk close to one
another. As the men cried out “This is sinful” and struggled to shield their genitals from touching the back of the
person in front, the soldiers would yank on the rope, thus
producing a reflexive motion where the back would arch
and the lower-body pelvic area would thrust forward. The
soldiers, he recalled, would chant, “Fuck him!” Rahman
reported an overwhelming sense of “embarrassment”
and terror as he watched. “I thought they were going to
do the same thing to me. I was so scared to be a part of
that. I used to thank God afterwards for being spared the
pyramid. I much preferred the cold water than that.”
In another “terrifying” incident, a group of five soldiers
descended upon him and threw him on the floor. As he
lay on his belly, with hands tied behind his back, soldiers
unleashed a snarling dog on him, while other restrained
dogs surrounded him and barked at his head. He was
not bitten, but added that he had seen another prisoner
being bitten.
After approximately nine months Rahman was
released in late May 2004 without charge. As a result
of his imprisonment by US authorities, Rahman lost his
business. He reported trying to relocate to a rural area,
away from Baghdad, but the aridity in that region forced
him to return to Baghdad. Rahman currently supports his
wife and eight children with savings and rental income
from their various home properties.

M edical E vidence of I ll - T reatment in U S D etention F acilities   3 7

In the summer of 2006 Rahman was “taken away” by
the Iraqi secret police and detained for eighteen days.
He disclosed this fact to the evaluators only at the very
end of the follow-up interview session and would not
provide any details about the experience. He went on at
length, however, about fearing for his life now. Rahman
reported an acute level of fear about being re-arrested
and his deep conviction that he was a “marked man”
because of his status as a former detainee held by the
United States.

Medical Evaluation

Reported Physical Symptoms
Rahman described having difficulty breathing and
experiencing chest pressure while imprisoned at Abu
Ghraib that resolved after his release. He reported that
at the time of his release, he experienced weakness
and had lost weight. He also reported musculoskeletal
pain, bruising, and headaches following his beatings. He
described a blow to the head that caused him to bleed
and rendered him unconscious. Rahman reported significant pain and discomfort in his right foot, and difficulty
bearing weight after he was pushed down the steps.
Rahman described experiencing urinary symptoms,
including frequency, urgency and a sense that he has
not completely voided, which started while in prison and
have persisted; he also reported experiencing decreased
sexual functioning.

Assessment of Physical Evidence
The physical symptoms Rahman described and the
physical examination findings strongly support his
reports of torture and ill-treatment. It is important to
note that many of the beatings Rahman described likely
resulted in additional bruises and soft tissue injuries,
which would not leave lasting physical marks.
The physical examination revealed a linear, depressed
scar on the center of Rahman’s forehead at the base of
his hairline. This scar is consistent with a scar caused
by blunt traumatic injury. He has two hyper-pigmentated
depressed oval scars on his right lower back. There is
also a depressed oval scar on the lower portion of his
left back. Rahman was unsure about the etiology of the
scars noted on his back, but the scars are consistent with
traumatic injuries, such as being kicked. Examination of
his right ankle shows signs of atrophy and tenderness
compared with the left. This is highly consistent with
Rahman’s report of the injury from being pushed down
steps while in prison. The significant pain and difficulty
of bearing weight on his right foot while detained, and
3 8   B roken L aws , B roken L ives

continued discomfort and difficulty walking, are likely
the result of this injury.
The difficulty breathing and chest pressure that
Rahman described are most likely somatic manifestations resulting from the acute stress of his imprisonment. The physical examination revealed a normal size
prostate, which was mildly tender. Rahman’s urinary
symptoms, decreased sexual functioning, and difficulty being aroused are also likely manifestations of
persisting stress from his imprisonment and ill-treatment, including the forced nakedness and sexual humiliations he experienced.
Medical Diagnostic Tests: Findings of a bone scan
provided further corroboration with his reported trauma.
The test revealed accumulation of nuclear material in
both feet and ankles, more prominent on the right foot
and ankle, particularly the right ankle. This is consistent
with a history of trauma, particularly to the right foot/
ankle as described. A blood test for prostate specific
antigen (PSA) was within normal limits. These findings
make prostatitis (inflammation of the prostate gland) at
the time of this evaluation less likely, but still possible.

Assessment of Psychological Evidence
Throughout the account, Rahman looked visibly tense
and showed a consistent pattern of minimizing the
description of his emotional impairments. In parallel,
although he explicitly stated his trust and comfort with the
evaluation, he alluded several times to his fear of people,
as well as his significant apprehension about participating in the evaluation. He clarified that, although he
wanted to “tell the truth to the world,” he was also reluctant about coming forward with his story. He expressed
concern about potentially being harmed again.
Rahman was focused, articulate, and finely discriminate in his physical-memory recall. He produced many
fine details about the physical features, objects, activities, and interpersonal exchanges that occurred during
his arrest and detention. For example, he described the
physical conditions of his cells at great length. Rahman’s
long-term memory was within normal range (except for
a few normative lapses and one significant deletion that
is addressed below). Throughout his narrative he consistently emphasized the points of social disgrace, such as
the shame of being arrested in front of the community,
the tarnishing of his reputation, and the destruction of his
business. Honor and dignity seemed to be of great significance to Rahman as he carefully conveyed the implications of acts that were injurious to his sense of dignity.
For example, he looked straight at the interviewers and

repeated several times, “The soldier called ‘shit’ to me.”
He wanted to be sure that the debasement of such verbal
insults was registered.
Rahman’s behavioral signs revealed strong indications
of an individual who was highly distrustful and uncomfortable about revealing himself, who was likely experiencing
substantial anxiety, and who applied a general approach
of avoidance (both in internal thought processes and in
overt action) in order to manage his fear and anxiety.
As mentioned, he reported symptoms of sexual
dysfunction that were still current, although he refused
to elaborate on the extent, triggers, or precise duration
of this problem.
Rahman reported experiencing several symptoms
during his arrest and imprisonment. He described
predictable fear reactions during his arrest, including
fearing for his life and worrying about his children. He
described rapid heart palpitations, trouble breathing,
and urinary frequency. His fearful reaction about losing
face and about the damage to his reputation was also
normal and consistent with his self-described valuation
of dignity and propriety.
When asked about his mental state during his detention, he described various experiences of distortion
in time and feeling “confused.” He confirmed having
frequent bad dreams and feeling generally “helpless,
no control.” In particular, he remembered growing to
feel terrified of the narrow confined space of his cell.
He reported, “I didn’t think I could take the small cell
anymore,” and would plead not to be taken back.
Rahman described feeling as if “I was going to lose my
mind.” Although he denied suicidal thoughts or attempts
(invoking his adherence to Islam), he recalled wishing
to die. Further, he added that “There was nothing to kill
myself with in the cell.” He denied wanting revenge or
redress for the harm done to him. “I just want the U.S.
to stop the violations.”
Rahman has developed a strong avoidance defense
mechanism, which made his evaluation difficult. “There
is too much fear, too much pain. So I try to push it
all away.” From his recounts it appears that Rahman
developed this defense mechanism of avoidance soon
after his release from prison, at the period during
which his post-traumatic stress symptoms were at their
most acute phase. There are many indications that this
avoidance continues to predominate. For instance, he
categorically emphasized not wanting his children to
know about his jail experience. “I want to stay strong
in their minds. I don’t want to ruin my reputation with
them.” Within his immediate family, only his wife knows

about the extent of his ordeal and, as a general rule, the
topic of Abu Ghraib is not mentioned between them. In
his own lay terms, he provided a typical description of
avoidance: “I never want to think or talk about it…I try
to get rid of my bad memories. I try not to stay alone,
[I try] to smile and have [a] cheerful attitude.” But he
acknowledged that this defense mechanism would falter,
“I would cry sometimes… when I remember what my
children went through.”
The fact of the predominance of avoidance as a defense
mechanism is directly relevant to two other psychological
data. The first concerns Rahman’s lack of clear memory
in the last months of his imprisonment (after being transferred to the communal tents). For example, Rahman
could not remember his date of release. As noted, he had
no recollection of being dragged around like a dog, yet
could not explain the discrepancy between his memory
and what other prisoners observed and told him. Although
it may be that the other prisoners saw someone other
than Rahman, if their observations are correct, his lack
of memory in the last months of his imprisonment may
be due to denial (to preserve his dignity) as well as dissociation (from the public shame of the disclosure that he
conceived of as unbearable). It may be that for Rahman
having the loss of his dignity and manhood become public
knowledge was equally, if not more, injurious. Avoidance
likely developed as a strategy — to deny that such injury
happened, and/or to preserve some pride by maintaining
a public denial.
Rahman spoke at length about memories and feelings
of humiliation in Abu Ghraib. He described an incident
of attempted rape, which he claimed he had never told
anyone about before. The description of his witnessing
the naked human pyramid was dominated by his memory
of being “embarrassed” for these men and of being terrified that he would be subjected to such “sinful” acts. He
stated that he used to feel shame merely at the thought
of this incident. As he spoke about it, he looked visibly
shaken. His eyes were averted. His face was contorted
in a seeming effort to control some internal discomfort.
His hand-rubbing and foot-twisting suggested a great
deal of anxious stimulation. Finally, he broke down in
tears when attempting to summarize his condition of
living with shame. He talked about the modesty of never
having been fully naked in front of his wife. In light of
this history, it was particularly traumatizing that female
soldiers had seen him naked, that his genitals had been
exposed, scrutinized, commented upon, and ridiculed by
a group of strangers.
In summary, there are ample indications that shame

M edical E vidence of I ll - T reatment in U S D etention F acilities   3 9

— that is, the subjective sense that his dignity had been
stolen, a sense of damage to his manhood, the sense
of humiliation vis-à-vis others — is a predominant and
intense emotional experience for Rahman. It seemed to
define his sense of self, pervade his thought process and
emotional reactions, and cause his avoidance.
Rahman’s descriptions of the few months after
his release from Abu Ghraib support the diagnosis of
PTSD during that period of his life. His descriptions of
this period clearly indicated symptoms of traumatic
re-experiencing (e.g., intrusive thoughts, nightmares).
For example, for the few months after his release from
Abu Ghraib, Rahman described that he would “just sit
and remember” his prison experience. “My mind used to
go to suffering. I wouldn’t even hear my family talking to
me.” He also described states of hyperarousal (e.g., loss
of impulse control, high irritability, and disturbed sleep).
He described himself as “not smiling,” “easily angry,” and
“disturbed.” “I would yell at the children a lot.” He was
also afraid of the dark and of being left alone in a room.
His sleep would be interrupted by the frequent urge to
urinate and by nightmares. He disclosed having many
intrusive thoughts of one guard in particular when he tried
to fall asleep. As noted above, Rahman developed a strong
avoidance defense (e.g., keeping to himself, avoiding
the topic of prison). All of these symptoms were clearly
directly linked to the traumatic imprisonment and torture
that he reported. When asked about his means of coping
during these months, he mentioned God and his wife.
Regarding inquiry into his sexual functioning, he
replied, “There is no joy. I don’t feel my manhood anymore.”
However, he declined to further elaborate regarding
the extent of this problem. He then maintained, “It’s a
medical problem. I have a problem with my prostate” and
strongly resisted considering any connection between his
sexual dysfunction and his torture experience.
Rahman no longer meets all the DSM-IV criteria for
a PTSD diagnosis, as only symptoms of avoidance still
persist. There are two plausible explanations. One is that
his post-traumatic stress disorder naturally remitted over
time. This is plausible but unlikely. Given the severity of
symptoms in his reports for that time period, the lack of
any kind of therapeutic interventions that might have alleviated these symptoms and ongoing stressors and potentially re-traumatizing events (i.e., the war, his economic
impotence, his re-arrest by the Iraqi secret police, his
ongoing sense of threat about being exposed and humiliated because of his Abu Ghraib history), one would expect
a continuation, if not exacerbation, of his symptoms. The
other possible explanation is that the patient is under4 0   B roken L aws , B roken L ives

reporting and denying the actual experience and level
of severity of his current psychological problems. This
would be consistent with his defense of avoidance and
his need to preserve any sense of dignity.
The subjective sense of shame and of damage to his
manhood and reputation is indisputable. This is a psychological injury that typically results from experiences of
violation and devaluation and is a significant, hallmark
injury of trauma victims. It leaves the person with a sense
of impotence, isolation, and fear. Rahman’s disclosures
about his subjective sense of self reflect this dynamic
of shame. In most clinical cases of shame and avoidance, the person can maintain some superficial basic
level of functioning, but harbors a deep sense of isolation. This often translates into an inability to cultivate
close, meaningful relationships and a pervasive sense of
dysphoria and hopelessness about one’s potential for a
productive and good future. In Rahman’s case, he denied
experiencing depression but showed many signs of interpersonal isolation, distrust, and hopelessness that often
correlate with the clinical syndrome of shame.
Results of psychological testing:42 On the self-report
measures administered, Rahman scored below the
threshold for a significant, diagnosable level of PTSD and
depressive symptomatology. On the BSI he reported a
pattern of low-moderate psychological dysfunctions on
various indices.

Analysis and Conclusions
Rahman demonstrates historical, physical, and psychological evidence strongly supporting his claims of torture
and ill-treatment while in the custody of US authorities in
Iraq. He provides substantial detail regarding his abuse,
yet he is forthcoming about what he does and does not
recall. The initial, profound reluctance to report a history
of attempted sexual assault, which he later revealed, is
consistent with an individual who has experienced such
traumatic events.
The detail with which Rahman described his imprisonment and torture, as well as the findings on physical
and psychological examination, supports his credibility.
That he had several scars which he acknowledged were
unrelated to his imprisonment and others the source of
which he was unsure of, further bolsters his credibility.
It is likely that he continues to suffer from the physical
and psychological effects of his abuse.
Psychological testing included the Beck Depression Inventory, the
Harvard Trauma Questionnaire, and the Brief Symptom Inventory
and the Dot Counting Test (a clinician-administered test of symptom
exaggeration).

42  

His description of a host of symptoms that signaled
the onset of post-traumatic stress disorder was consistent with the report of antecedent traumatic events. It
was further consistent with the subsequent description
of patterns of defensive behaviors that indicated avoidance. For when avoidance is reported — and observed
— in the pervasive and consistent manner that was
in Rahman’s case, it is usually motivated by profound
psychic trauma, the kind that overwhelms the person’s
psychological resources and undermines his sense of
safety and integrity (hence the development of avoidance
in order to preserve some sense of intactness and to
minimize further injury). Thus, the development of avoidance as a predominant defense mechanism is logical
and consistent with the reported trauma of torture and
violation, with the onslaught of post-traumatic stress
symptoms, and with the high valuation that this individual
placed on dignity and pride.
The scores from the psychological instruments do
not cohere with the data that emerged from the patient’s
unstructured reports and from his self-disclosures and
emotional reactions, where shame, fear, a sense of
“disease” and general hopelessness come through in a
consistent and dramatic progression. When considered in
light of the totality of other psychological data, the pattern
of low-to-average scoring in psychological instruments is
expected and consistent with the observed avoidant defensive mechanism. Further, the higher endorsements on
phobic anxiety and paranoid ideation are consistent with
his described sense of distrust and general preference
to avoid contact with people. This is an individual whose
main way of coping is to avoid exposure, deny his distress,
minimize his sense of injury, and “push it away.” Thus, one
can reasonably view his low endorsements on the objective
standardized tests as one derivative of his general defensive effort to distance himself from his own distress.
Given the totality of the clinical data collected from
this evaluation, solid evidence supports a conclusion of
significant physical and psychological injuries as well as
consistency and credibility in Rahman’s reports of symptoms and trauma history.

P r o f i l e 7 : A mir

43

Amir was arrested in August 2003 in Baghdad and
remained in US custody until January 2005. He was
subjected to brutal sessions of beatings, stress positions,
Amir’s medical evaluation was conducted by Allen Keller,
MD and Leanh Nguyen, PhD.

43 

sodomy, forced nakedness and sexual humiliation, and
noise bombardment, as well as other forms of torture.
Amir continues to suffer from physical and psychological
symptoms since his release. He reported several marked
impairments in his social, sexual, and emotional functioning subsequent to his detention.
“No sorrow can be compared to my torture experience in jail. That is the top reason for my sadness. I
cannot forget it.”

Background
Amir is an Iraqi man in his late twenties who spent some
time as a refugee in another country when he was a child.
After the Iran-Iraq war, his family returned to Iraq, where
he received an elementary-school education. At the time
of his arrest, Amir made a living as a salesman. He was
the sole provider for his family, which consisted of his
mother, his younger brother, his younger brother’s wife,
and their three children. He was also engaged to a longtime neighborhood friend whom he married shortly after
his release from detention.

Allegations of Arrest and Abuse
Amir reported that early one morning in August 2003, US
soldiers raided his room at a Baghdad hotel while he was
sleeping. He and other individuals were informed that if
they moved they would be shot. Amir was blindfolded,
his hands were shackled behind his back and he was
taken in a truck to Saddam Hussein’s former palace.
He recalled that he had a severe stomachache when he
arrived there. “I begged the American soldier to permit
me to go to the bathroom… When he saw I was in a very
bad case, he said, ‘Sit down here,’ and I made my toilet
there in front of him.”
A few hours later, Amir was transported by truck
to another location that he could not identify. He and
other detainees were required to sit on their knees for
about two hours, with their hands bound and eyes blindfolded. Later, they were taken to another room, where
they were required to remove their clothing. They were
photographed while naked and were forced to stand for
approximately five to six hours. He was blindfolded, and
his hands were tightly shackled. Amir recalled, “We were
in a miserable [state].” He remembered feeling hungry,
thirsty, hot, and tired.
Amir reported that during this time he and other
detainees were questioned about their background. He
noted that the detainees complained and “asked the
soldiers to permit us to sit down.” They were instead
told, “Now, we will make you dance.” The soldiers played

M edical E vidence of I ll - T reatment in U S D etention F acilities   4 1

“a very frightening voice” loudly over a stereo and forced
the detainees to run around in a narrow room. This forced
running continued over the course of the next three days.
The detainees were denied rest or sleep and were forced
to eat while standing.
During this time, Amir’s left foot was injured: “I noticed
my blood everywhere.” Nonetheless, he was forced to
continue running. He described that he leaned against
a stretcher, and reported his foot injury to the soldiers.
One of the soldiers raised the stretcher sharply and he
was thrown against a wall, hitting his head and losing
consciousness. After regaining consciousness, Amir
recalled that an interpreter hit him on his nose with a
plastic water bottle, causing it to bleed. Amir believed
that his nose was broken. Subsequently, he was forced to
stand and was questioned along with the other detainees.
After this incident Amir noted marked difficulty walking,
and there was swelling in his knees and foot.
Amir recalled that his interrogators threatened to
send him to Guantánamo Bay if he was a terrorist. Amir
reported that after three days of sleep deprivation and
forced running, the prisoners were allowed to sleep.
However, he recalled that the forced running and sitting
on their knees continued for about ten days.
Amir was then taken to another location, where he
remained for several days. In the course of being transferred, plastic handcuffs placed on him were tightened
to the point of causing his hands to swell and turn blue.
Amir reported being held at this facility for twenty-seven
days in a small dark room, where he was fed only twice
daily and had to use a bucket as a toilet. He added, “You
make your toilet in this bucket and you eat right next to
it.” He was repeatedly interrogated during this time. In
certain sessions interrogators pushed his head against
the wall. He recalled that the soldiers humiliated him
for having swollen knees. In one interrogation, while he
was blindfolded and his hands were bound behind his
back, he was forced to bend over and “walk zigzag and
sometimes [was] pushed into the wall.”
In September 2003, Amir was taken to Abu Ghraib
prison. He was placed in a cell and told not to speak.
When he continued to speak, soldiers pushed him to the
ground and called him a “girl” in Arabic. He was subsequently shackled to the door of another cell for two hours
before being returned to his cell.
Except for the abuse he experienced on arrival, Amir
recalled that he was generally treated well during his first
month at Abu Ghraib. The food was better than before,
and he was allowed to help soldiers distribute food to
other detainees. However, he remembered that his situa4 2   B roken L aws , B roken L ives

tion changed when a new group of soldiers arrived at Abu
Ghraib. He recalled that a soldier mistakenly suspected
him of throwing a piece of food to a prisoner in another
cell. The soldier yelled at him, “Bullshit, fuck you, fuck
you.” Amir recounted, “I can never forget these words
because I knew he was insulting me.” He was denied
food that day, and that night soldiers took him to another
room, restrained one of his hands to the wall, and put a
bag over his head. A soldier lit a cigar and blew smoke
into the bag over Amir’s head. Amir recalled having a gun
run up his body, poking at him, and pressed against his
face. He was then taken back to his regular cell and told
to sleep but, after fifteen minutes, the soldier returned
screaming at him, took him back to the other cell, and
tied him to the wall. Over the next two days the procedure
was repeated four to five times. Amir described being
deprived of sleep because the soldiers would hit a barrel
or the doors of a cell with a hammer. “Because of this
we could never sleep. Even if they permit you to sleep,
you could not because of this.”
During the course of detention, Amir recalled experiencing several other abuses. On one occasion, Amir was
playing with a broken toothbrush while sitting in front of
his cell. When the soldiers saw this, they confiscated the
broken tooth brush and accused him of manufacturing a
dangerous weapon. They told him to take off his clothes.
Amir recalled that he pleaded that his religion forbids
nakedness. He was nevertheless restrained naked to
the bars of his cell’s door for two to three hours. He was
then returned to his cell naked and without a blanket.
He noted that the soldiers would come to his cell and
humiliate him because of his nakedness.44
Amir recounted remaining naked and being forced to
pray in that condition. During that time, he recalled that
a soldier came to his cell and started shouting. Amir
was praying, so he did not answer. The soldier entered
the cell, and pushed Amir’s head to the floor. He was
then suspended with his arms up and behind his back
for several hours, with only his toes touching the ground.
During this time, Amir also heard increasingly highpitched screaming from, in his words, “others who were
tortured. The screaming was getting higher and higher.”
Subsequently, Amir was taken to a small foul-smelling
room and was forced to lay face down in urine and feces.
He noted, “You can’t even breathe because of that smell…
[The soldier] pushed me to lie down. I tried to move my
shoulder so my face would not go to the ground. They
PHR was able to corroborate this episode of Amir’s abuse with
General Fay’s report. Fay Report, supra note 18, at 76-77.

44  

brought a loudspeaker and started shouting in my ear. I
thought my head would explode.” Amir reported that a
broomstick was forcibly inserted into his anus. He was
hit and kicked on his back and on his side. At this point,
he was bleeding from his feet and shoulders, and the
urine exacerbated the pain from these wounds. He was
pulled by a leather dog leash and was ordered to “howl
like dogs do.” When he refused to do so he was repeatedly kicked. Amir felt a hot liquid on his back and guessed
that someone was urinating on him. He received more
kicks on his left side and in the groin, and one of the men
stepped on his genitals, causing him to faint.
Amir subsequently woke up to cold water being poured
on his head. He recalled hurting all over his body, particularly on the left lateral side of his chest, his right middle
finger, and his groin and genitals. He noticed that his
genitals were swollen and had wounds.
When asked about his internal responses to this
episode of abuse, Amir described, “My soul was flying
away. Like my body was not there. I started to think about
my family …When I woke up [from the beatings], I felt like
I was not of this life. But my body was there, the pains in
my body were there.”
Following this episode, Amir was kept naked in his cell
for about four days. During that period, representatives
of the International Committee of the Red Cross (ICRC)
visited him and he told them about his ill-treatment. The
ICRC personnel provided him with clothing and blankets,
which were confiscated after they left. When the Red
Cross returned the following day, these provisions were
given back to him — only to be taken away again when
the visitors left.
Amir noted, “After four days, they gave me back my
clothes and blankets and I went back to normal prison
routine. By normal I mean they stopped hitting and
torturing me.” Amir reported that the soldiers started
calling him “Tarzan.” That nickname was written on a
piece of paper and pasted on his cell door for six days.
Explained Amir, “They called me this, because I had the
toothbrush in my hand and I was naked like Tarzan, who
held a knife and was naked. The interpreter explained
this to me in detail.”
When asked “Did any doctor help you with your injuries?,” Amir uncharacteristically interrupted the interviewer and cried out, “Did I need to ask for help? I was
there naked and bleeding. They were supposed to help…
These were not real doctors. They had no compassion. They
were not there to practice medicine but to make war.”
He reported that he remained in that cell, alone, for
another two months and then was transferred to the

communal tents at Abu Ghraib. In July 2004, Amir stated
he was transferred to Bucca prison, and then in November
2004 was returned to Abu Ghraib for two days before being
finally released without charge. He did not report any
torture or ill-treatment while at Camp Bucca.
In addition to the abusive treatment Amir reported
directly experiencing, he also reported witnessing other
prisoners being tortured and humiliated. Once, he saw
naked prisoners being forced into a pile that formed a
human pyramid. On another occasion, he was forced to
watch two prisoners appearing to simulate anal intercourse. Amir stated, “[The prisoners] were begging ‘This
is a sin against our religion, please show mercy.’ The
soldiers were pushing them into each other, and these
guys were trying to [push] away, and this [lasted] more
than half an hour and this was in front of our eyes.”

Medical Evaluation

Reported Physical Symptoms
Amir reported feeling extremely weak, losing a great
deal of weight, and experiencing severe headaches during
his detention. While the headaches have improved, they
persistently occur approximately once every one to two
weeks. The headaches can be induced by feelings of
nervousness, hunger, or anger; are often associated with
vomiting and sensitivity to light; and can last from one
hour to several hours or even an entire day. Amir also
experiences periods of dizziness since his detention.
Following the reported sodomy, Amir described having
rectal bleeding and painful bowel movements that lasted
approximately two weeks. The injuries to his genitals
caused him chronic penile pain (lasting more than two
months); blood in the urine (for about two weeks); and
significant scrotal pain that gradually improved. He
continues to have chronic discomfort in his left testicle,
including during sexual intercourse.
Following the beatings, Amir described having pain
all over his body. He continues to experience pain in his
back and knees (particularly when walking) and discomfort in his right middle finger and in his left big toe while
walking. Moreover, Amir described having persistent
significant left lateral-side chest pain, which hindered
him from sleeping on his side for more than one and
one-half years. Also, since the trauma to his nose while
in prison, Amir has had difficulty breathing. He reported
that he continues to experience some discomfort when
sleeping on his left side, and it gets worse when he takes
a deep breath.
Amir described currently experiencing palpitations
(irregular heartbeats) multiple times every day. The

M edical E vidence of I ll - T reatment in U S D etention F acilities   4 3

palpitations would typically last a few minutes, and he
attributed them to his memories of abuse. “These are
the memories I can never forget…I want to forget, but it
is impossible.”

Medical Diagnostic Tests: Bone scan findings are consistent with a history of trauma to his ribs. Further, accumulation of the nuclear materials in both feet and ankles are
consistent with a history of trauma to these areas.

Assessment of Physical Evidence

Assessment of Psychological Evidence

Many of the beatings Amir described would likely have
resulted in bruises and soft tissue injuries that would
not leave lasting physical marks. However, the physical
symptoms he described and findings on physical examination strongly support Amir’s reports of torture and
ill-treatment. Physical examination revealed a slightly
curved and depressed scar on the left lower side of the
nose, a slight bony prominence on the top left side of
his nasal ridge, and a faint crackling sound on palpation at the tip of the nose. The several scars noted on
his head are consistent with the reported kicks or other
blunt trauma injuries that he sustained during detention. Further, several scars were noted on his hands.
Thickening of skin and prominent linear scars on the
knees is consistent with Amir’s reports. The two-centimeter raised hypo-pigmented (i.e., lighter than the
surrounding skin), slightly angled, fibrotic band at the
base of his left big toe is highly consistent with a scar
resulting from a significant laceration and subsequent
bleeding that Amir described.
Musculoskeletal examination was significant for some
slight tenderness over his scapular regions bilaterally,
and tenderness over the area of the left lateral sixth rib
with a slight prominence noted on palpation.
The genital examination showed there was tenderness to palpation of the left testicle and a fibrous band
between the base of the head of the penis and the shaft
of the penis that Amir reported did not exist before. This
is highly consistent with the events Amir described,
including a traumatic injury and subsequent scarring
process. Examination of the peri-anal area showed signs
of rectal tearing that are highly consistent with his report
of having been sodomized with a broomstick.
The continued scrotal discomfort that he described
is likely as a result of the injuries to this area that he
reported sustaining.
Chronic headaches and dizziness are common among
torture survivors who have experienced head trauma.
The headaches and dizziness that Amir described, which
he did not have prior to his imprisonment, are likely to
be a result of the head trauma. Moreover, his continued
psychological symptoms and distress likely contribute
to these headaches as well.

Prior to his arrest, Amir described himself as a “calm
and gentle person”, who has been an effective provider,
“good” to his family, and “smooth” and “patient” with
everyone. In contrast, he described feeling that his family
has been shattered and that much calamity had fallen
on them because of him, and he spoke at length about
feeling helpless to protect or provide for his family.
Following his release, Amir found himself constantly
being “nervous” and “on edge.” He described a high level
of stress caused by bombings, nightly raids, uncertainty
about personal safety, frequent funerals of neighbors
and acquaintances due to the war, and ongoing sadness
about the losses that his family had sustained. Moreover,
as a result of conditions related to the war, Amir was
unemployed at the time of evaluation. Nevertheless, Amir
emphasized that his post-prison, war-related stressors
are not the primary reason for his emotional “disturbances.” He stated, “No sorrow can be compared to my
torture experience in jail. That is the top reason for my
sadness. I cannot forget it.”
Amir’s reported symptoms and behaviors conform to
all three clusters of PTSD symptoms including intrusive
recollections of the trauma, hyperarousal, and avoidance.
These symptoms are directly traceable to the traumatic
experience that he reported.
Amir described suffering from flashbacks and intrusive
memories. His days are often preoccupied with images
and thoughts of his experiences at the prison. He added,
“It is like in my head I have never left Abu Ghraib.” He also
suffers from flashbacks and recurrent nightmares about
his traumatic imprisonment. He confirmed experiencing
distress, including fear and outrage, and exhibits physiological reactivity (i.e., startle response, throat constriction, chest pain, heart palpitations) upon being exposed
to cues that are reminiscent of the trauma, such as the
sight of US soldiers or the recollection of his torture.
He reported numerous symptoms of hyperarousal
including suffering from severely disturbed sleep, often
sleeping approximately two hours a night; moodiness;
outbursts of anger; exaggerated startled response; and
low tolerance (“I constantly feel disturbed. I would break
everything in the house. When I disagree with my wife, I
would smash things.”).

4 4   B roken L aws , B roken L ives

In addition to the above symptoms of re-experiencing
and hyperarousal symptoms, Amir described symptoms
of avoidance and emotional numbing, including having
trouble being naked in front of his wife; avoiding open
space, people, and social activities; and feeling flat or
constricted in his emotions (“Maybe I feel about one
quarter of my feelings.”). He also confirmed feeling
isolated, as well as detached or disinterested in forming
social relations after his release from prison.
Amir described feeling helpless and having a “dark”
sense of the future. Moreover, he articulated a sense of
wounded pride and stolen honor. He explained that the
dissemination of photographs from Abu Ghraib on the
Internet had exposed his humiliation to the world. He
is plagued with an acute sense of scrutiny wherever he
goes. Worse is his perception that this public knowledge
has ensured that his children will suffer the blame and
dishonor of his reputation as a former detainee and will
thus be at risk for a life of shame.
Amir disclosed that he constantly harbors suicidal
ideation, although he adheres to the teachings of Islam,
which prohibit suicide. He further described that while in
prison he tried to kill himself by banging his head against
a hard surface. He reported frequent thoughts of revenge
and homicidal fantasies.
The symptoms of sexual dysfunction are consistent
with a previous history of sexual violation. As noted
above, he reported having trouble being naked in front
of his wife. He described being easily scared by his wife’s
sudden, even slight movements in sleep. Flashbacks of
his torture, especially the sexual aspects, would often
intrude during sex with his wife. In such instances, he
would then “lose all strength.” Along with this symptom
of erectile dysfunction, he also reported low sexual drive
and minimal interest in sex. Amir specifically described
triggers, context, and time frame that connect the sexual
dysfunction to the traumatic violation of his experiences
at Abu Ghraib. The impairment is likely linked to posttraumatic re-experiencing of the sexual violation.
Psychological Tests:45 with no evidence of deliberate
exaggeration. On the self-report measures administered,
Amir reported several symptoms of PTSD, anxiety, somatization, hostility, paranoid ideation, phobic anxiety, and
obsessive-compulsiveness, interpersonal insensitivity,
and depression. Although his score on the BDI suggested
a moderate-high level of depressive state, it did not
Psychological testing included the Beck Depression Inventory, the
Harvard Trauma Questionnaire, and the Brief Symptom Inventory
and the Dot Counting Test (a clinician-administered test of symptom
exaggeration).

45  

approach the diagnostic level of clinical depression. On
the Dot Counting Test, a clinician-administered test of
symptom exaggeration, Amir’s performance earned him
a score within the normal range

Analysis and Conclusions
Amir demonstrated historical, physical, and psychological evidence strongly supporting his allegations of
torture. He provided substantial detail regarding many
components of his abuse. He was forthcoming about
what he does and does not recall.
Amir appears to have been suffering from physical
and psychological symptoms since his release from Abu
Ghraib, and described several marked impairments in his
social, sexual, and emotional functioning subsequent to
that experience. These impairments are consistent with
Amir’s allegations of having been subjected to extreme
ill-treatment, injuries and threats, and of having experienced an intense degree of terror and helplessness
about the integrity of his mind and body.
The physical symptoms Amir described and findings
on physical examination strongly support Amir’s report
of torture and ill-treatment. The ongoing physical effects
of his abuse include headaches, dizziness, musculoskeletal symptoms, and decreased sexual drive. These
physical effects may have psychosomatic aspects as
well, as a result of the PTSD from his imprisonment and
ill-treatment.
The psychological findings on Amir’s current symptoms and mental status during the evaluation are highly
indicative of significant psychological injuries. The cumulative psychological findings form a coherent and realistic
pattern of severe PTSD impairments. His clinical profile
is highly consistent with a history of severe traumatic
violation. The particular constellation of symptoms documented cannot be accounted for by psychological maladjustment prior to his arrest and imprisonment, as Amir’s
description of the pre-arrest period suggests that he was
psychologically well-adjusted and resourceful, and his
account of his feelings, self-experience, and functioning
following his release from Abu Ghraib is highly consistent
with the onset of PTSD. Amir’s high percentile rankings
on the indices of somatization, anxiety, hostility, phobic
anxiety, and paranoid ideation concur with the clinical
profile of an individual suffering from post-traumatic
stress and lend further support to the above diagnosis
of PTSD.
While stressors related to the current war in Iraq and
to his public status as a former Abu Ghraib detainee may
have exacerbated some of his symptoms (e.g., his sense

M edical E vidence of I ll - T reatment in U S D etention F acilities   4 5

of distrust and scrutiny, sense of economic impotence,
anticipatory anxiety about further arrest), his most debilitating symptoms are tightly connected to his experiences
while imprisoned and subjected to torture, ill-treatment
and sexual violations. Moreover, the pattern, extent, and
course of his symptoms are more likely and coherently
explained in connection to his experiences during imprisonment than to the stressors of unemployment or daily
life in a war-torn region.
The manner in which Amir described his detention
experience, both in content and in style, as well as the
clinical findings lead us to conclude with high confidence
that he is credible.
In conclusion, the evaluation produced findings that
support significant physical and psychological injuries
from torture as well as consistency in Amir’s symptoms
and trauma history.

P r o f i l e 8 : H aydar 4 6
Haydar came to be in US custody after being detained
first by the Taliban and then by Afghan forces allied with
the United States in late October or early November
2001. He was held in Kandahar and Guantánamo Bay
detention facilities, where he was subjected to beatings,
sexual and cultural humiliation and extreme temperature manipulation. He was released in the summer of
2004. The medical findings show that his ill-treatment
led to a major depressive episode, post-traumatic stress
disorder, and panic disorder. Additionally, visible scarring is consistent with Haydar’s allegations of physical
abuses endured.
“[In Guantánamo, a] female soldier subjected me
to pepper gas and then sprayed me with water with
extreme force, and I was writhing on the ground
in pain.”

Background
Haydar, who grew up in a large middle-class family, is
in his late thirties. He described his childhood as quite
happy but reported being unhappy for having resigned
himself to an “intolerable” marriage. He has four children,
whom the youngest is now ten years old. He reported
becoming severely depressed and increasingly desperate
over the year prior to his arrest and eventually traveled
to Afghanistan as the result of this desperation.
Haydar’s medical evaluation was conducted by Allen
Keller, MD and Barry Rosenfeld, PhD.

46  

4 6   B roken L aws , B roken L ives

Having dropped out of high school, Haydar explained
that he held many different jobs but “didn’t have a profession.” After he was married, Haydar launched an unsuccessful business that left him deep in debt. He reported
that the ensuing severe financial difficulties led him to
make the risky decision to spend all his money trying
to win a lottery, which in turn caused him to lose his
remaining money.  He recalled that he read a newspaper advertising lucrative employment opportunities
in Afghanistan. (“I read that they give a house, a car and
work to those who are willing to work in Afghanistan.”)
He decided to leave for Afghanistan but he reported that
he made it only as far as the border before being picked
up and detained by the Taliban.
Haydar reported that the stresses of his personal
situation led to psychological symptoms even before
his detention experience, noting that he had attempted
suicide twice, had severe sleeping difficulties, and diminished appetite and nausea due to excessive cigarette
smoking and daily alcohol use.

Allegations of Arrest and Abuse
Haydar reported that he was initially arrested by the
Taliban shortly after his arrival in Afghanistan in late
October or early November 2001. Easily identifiable as
a foreigner because of his “Western” clothing, he was
accused of not being Muslim because of his lack of a
beard and inability to read the Koran. He was detained
in two separate locations for seven or eight days and was
eventually transferred to a house with ten or twelve other
people where “they gave us food and drink” and told us,
“You are our guests.” Subsequently, Afghan forces allied
with the United States raided this house. Haydar and the
others had their wrists tied, were struck in the head, and
then put on a minibus. He recalled, “They were beating
us on the way, and they put us in a small prison.”
Haydar recalled being beaten severely by “American
allies” in this facility and was struck with rifle butts,
kicked, and beaten with shovel handles, causing his
mouth to bleed. He was kicked in the side of the head
and described that the injury was “like a fountain [of
blood] — my clothing had blood — it shot out of my ear
— the membrane exploded inside my ear.” They then
took him to a room covered in feces, kicked him such
that the feces were forced into his mouth. He recalled, “I
was just thinking [about] when . . . the strikes would end
and [if] I [was] going to die.” He also described having
had his testicles pulled very hard for several minutes
but did not believe he had suffered any damage as a
result. Haydar remained in this prison cell for nine days

before being transferred to another prison, “Ismail Han
Zindan,” where he remained for approximately two to
three months.
At Ismail Han Zindan prison, run by Afghans allied
with the United States, he was visited by representatives
of the ICRC, who brought him blankets and soap and
water for bathing. Haydar reported that he was hungry
during much of his detention at Ismail Han Zindan.
There was no water or bathing facilities for the prisoners, and “we didn’t need to search for lice on [our
bodies]. You could scoop them up in your hands.” This
prison held 200-300 detainees and, according to Haydar,
it was “very crowded,” with fifty people staying in units
built for fifteen to twenty people. American personnel
eventually shackled and hooded him, transferring him
by air to the US facility at Kandahar. During transfer he
recalled having difficulty breathing because of the hood
and thinking about “torture, fear of death…that they were
going to kill you.”
Upon arrival at the Kandahar facility, chains were put
around his feet, wrists and hands from behind. He noted,
“[Americans] cut all of our clothing [off] with scissors —
everyone there was stark naked, and everyone could see
each other’s sexual organs.” He noted feeling humiliated,
and added, “There were many women in the group of
soldiers. One of the soldiers made me bend over and
inserted a finger into my anus — I don’t know if it was
medical or to humiliate me.” He stated that a soldier
“sprayed us everywhere with something that smelled
like insect repellent — and they shaved everything on
our body. Then they dressed us and put hoods over
our heads.”
Subsequently, he was forcefully kicked while on
the ground, causing his lip to swell. He reported being
“beaten so mercilessly that three of my teeth fell out and
a fourth was taken out in Guantánamo…They kicked me
so hard that I had a very large bump [on my head]…It
was so large that the doctors removed it.” When asked
how long the beatings lasted, Haydar replied, “If I said
hours it would be an exaggeration, because if someone
beat you like that for hours you would die, but I was
beaten for at least 10 minutes.” At that point, he both
believed and wished that he would die. Haydar recalled
having been interrogated three times in the three days
he was held at Kandahar. He reported that the soldiers
“hit my head against wooden columns” while he was
being taken to his first interrogation. He was repeatedly
asked the same questions: “Are you a terrorist? Are
you Taliban?” After these three days, and still in pain
from the initial beatings he received on arrival, he was

hooded by American personnel, placed on an airplane,
and transferred to Guantánamo. During the flight, he
and the other prisoners were chained to hooks on the
floor in a crouched position. “I might have passed out. I
couldn’t think of anything other than the pain in my back
in that position.”
Haydar did not find out that he was at Guantánamo
until months after he had arrived. Similar to their treatment at Kandahar, upon arrival to Guantánamo, he and
the other detainees had their clothing cut with scissors.
Haydar said that they were sent to communal showers,
where they bathed while soldiers, some of whom were
female, watched and laughed. After the showers, they
were again chained and “a doctor put a finger in our
anus.” When asked how he knew the individual was a
doctor, Haydar replied, “I’m saying ‘doctor’ in order to
comfort myself now.” The detainees then were dressed,
hooded, and beaten by the soldiers while they walked to
their cells. Soldiers kicked them and threatened them
with dogs (“I still see the dogs in my dreams — that they
are coming for me and are going to bite me.”) Although
Haydar was not bitten, he reported at one point seeing
another detainee being bitten. Haydar added that he was
hit with fists, kicked, and dragged on the floor. He reports
bruises and bleeding “all over” from this treatment. He
recalled, “In fact, the next day when they took me to the
doctor, the doctor couldn’t control his own tears, saying
[to the military guard], ‘How could you do this to him?’”
He noted that the doctors treated his wounds and “they
gave me injections and made me take medicines” but
added that he was unsure what medications he was
given or why.
Following this incident at Guantánamo, Haydar denied
any other severe physical abuse, although he described
a number of occasions in which he suffered significant
physical pain. For example, he recalled having been
sprayed with pepper spray (“This one female soldier
subjected me to pepper gas and then sprayed me with
water with extreme force — and I was writhing on the
ground in pain.”)
Haydar was held in one cell for about three or four
months before being transferred to a second camp at
Guantánamo. Haydar described the conditions in the first
camp as “egregious — the conditions we were living in
— We were treated like animals-they were treating the
dogs better than they were treating us.” He explained
that his cell had only a bucket to use as a toilet and a
second bucket for water.
During his transfer to the new camp, Haydar was
hooded, his hands and feet were chained, and he was

M edical E vidence of I ll - T reatment in U S D etention F acilities   4 7

put in a vehicle that brought him to the second camp.
“Our bodies [were] pushed forward [causing] back and
neck pain. The pain was so bad that I would cry from the
pain.” In the second facility, the toilet and water situation in the cells were improved, but Haydar noted that
“the other one was airier.” He noted that the new camp
was similar to the first one, but he was allowed to go to
a small recreation area for ten or fifteen minutes once
or twice a week. He added, “I wasn’t beaten, but I was
subjected to the pressurized water,” which soldiers would
spray on the detainees while they were sleeping under
the guise of cleaning the cells. Haydar also reported that
soldiers would yell and taunt detainees during the call
to prayer and would sometimes spit in or throw out part
of their food rations. However, he noted that not all of
the soldiers were so malicious, and some “treated us
well.” Haydar estimated that he spent approximately two
years in this second camp before being released. During
this time, he recalled being interrogated approximately
twenty times. In at least one instance, he recalled having
been forced to sit in an extremely cold room with his
hands and feet chained to a ring on the ground.
While in Guantánamo, Haydar recalled hitting his head
against the door many times “so hard … that I would faint”
and explained, “I had a lot of pain in my chest — it felt like
I was choking.” Haydar reported receiving psychological
and medical care throughout his detention. He stated
that the soldiers “called me crazy there and the doctors
told them to leave me alone,” despite the fact that he
would frequently spit or throw water at them. He noted
that he was prescribed Zoloft for much of the two years
he was detained in Guantánamo and saw a psychologist regularly. He explained, “I was having really bad
nightmares…I felt like I couldn’t breathe. They gave me
repeated injections in my hips to calm me down.” Haydar
indicated, however, that he suspected the psychologists
shared information with the soldiers.
Haydar also described numerous physical problems
from which he suffered while in Guantánamo, including
headaches, chest pain, and pain in his back and left
side, as well as numbness in his legs and hands. He
was given injections and believed they were treatment for
these pains. Haydar recalled seeing doctors frequently
(“almost every day — Sometimes a doctor would come
and put a chair down and observe me for an hour or
so. He would watch me, observe me walking, eating,
how I interacted with people in my environment.”) He
also reported having had several operations to remove
a large bump caused by being beaten in Kandahar. He
noted that he continues to have headaches periodi4 8   B roken L aws , B roken L ives

cally and acknowledged that they had worsened since
his incarceration.
In addition to medical and mental health treatment,
Haydar recalled being seen by representatives from the
ICRC on many occasions. However, he noted, “They didn’t
pay much attention to us because they didn’t speak our
language.” He stated that he was never given the opportunity to speak with a lawyer.
Haydar was eventually released, without any charges
being brought against him, in the summer of 2004. He
recalled, “They took our photographs. As soon as we
boarded the plane they bound our hands and feet and put
sacks over our heads.” He recalled thinking, “We are not
free; they are taking us to kill us. And just as I was taken
in chains and a sack in this abusive way from Afghanistan
to Guantánamo, they took us from Guantánamo to [my
home country]. In front of the Red Cross and media and
cameras, they made it look like we were free, but as soon
as we were on the plane we were bound again.”
Haydar noted that he was never asked by US officials
to sign any documents or confessions prior to being
released but stated that his home government asked
him to sign statements upon his arrival in his home
country. He stated that he was detained for several days
upon his return and was interrogated extensively about
his experiences in Guantánamo; he did not report any
abusive treatment by the local police. When asked to
describe the documents he signed, Haydar replied, “I
don’t remember anything. I was completely exhausted
— I have no idea what I signed.” He stated that he later
contested the validity of the documents and was ultimately released.
During his detention in US custody, Haydar’s family
experienced great upheaval: his wife left him, and his
father was killed. Haydar explained that it still causes
him pain to think about these events. He stated, “At this
very point, when you mention it, I feel a pain in my chest.”
After his release, Haydar reported he was unable to
find employment. “I tried very hard, but I can’t work — I
tried a few times but I experienced intense pain in my
back and I couldn’t sleep through the night. I applied
for a few jobs for lighter work but I didn’t get them.” He
noted that he has occasionally found work for a day or
two, through friends, but described this as infrequent.
He added that he subsequently relocated, after gaining
custody of his children, and his mother has moved into
his home to help with their care.
Shortly after his release from Guantánamo, Haydar
received treatment for his physical and psychological
problems at a center affiliated with the International

Rehabilitation Council for Torture Victims (IRCT). He
stated that he continued taking Zoloft, an antidepressant medication he was given by the US doctors at
Guantánamo (“From America they had given me a bag
full of medicine”). He stated that he continues to take
antidepressant medication, although he acknowledged
many continued symptoms and difficulties.
Haydar stated that, despite his continued physical
and psychological difficulties, he maintains many social
relationships and has been engaged in romantic relationships. He noted, however, that he is somewhat more
withdrawn than he was before his arrest and detention and added that he has also increased his cigarette
smoking considerably, from approximately one pack per
day before his arrest and detention to nearly two packs
per day, explaining, “I feel more relaxed when I smoke.”

indented atrophic scar on the back of his left forearm.
He attributed this scar to being pulled on the floor while
at Guantánamo. He has a hypopigmented linear scar on
his right ankle, which he attributed to shackling while
imprisoned. A faint hypopigmented scar at the base of
his right and left wrists were reportedly injuries resulting
from, and are consistent with, handcuffs rubbing against
his skin. Haydar also has several dermatologic findings,
which he reported were unrelated to his imprisonment.
The forensic evaluation report conducted in 2004 by
representatives of a center affiliated with the IRCT and
reviewed by PHR professionals revealed a number of
similarities to the findings of the present evaluation.
Medical Diagnostic Tests: A total body scan conducted in
2004 by a center affiliated with IRCT revealed no evidence
of abnormalities.47

Medical Evaluation

Assessment of Psychological Evidence

Assessment of Physical Evidence
Haydar reported experiencing daily chest pain and
occasional headaches that began while he was in
Guantánamo, although the pain has improved after his
release. Haydar also described experiencing persistent
stomach pain, which has improved with the medicine he
has now been prescribed. Haydar described experiencing
daily lower back pain and numbness in his legs, which
began while he was in Guantánamo and is exacerbated
by lifting heavy objects and walking. He reported that this
pain wakes him up every two to three nights. He attributed this pain to having been chained in a “bent over”
position for extended periods of time (e.g., during the
plane ride to Guantánamo and whenever he was outside
his prison cell).
Haydar’s physical examination yielded several significant findings. He has poor dentition with several missing
teeth, consistent with his report that three of his teeth
were knocked out when he was beaten in Kandahar,
with a fourth extracted while he was at Guantánamo.
He is missing three other teeth, which he reported were
extracted prior to his imprisonment. A musculoskeletal
examination revealed some pain when he tried to flex
or elevate his leg, which was greater on the right side
than on the left. There is point tenderness with palpation over the lumbosacral region (vertebrae and bones
in his lower back).
Haydar also had numerous scars on his body, some of
which can be attributed to his treatment while in detention. There is a jagged scar extending laterally on the left
side of his lower lip consistent with his report of being
kicked in the lip. Dermatologic findings include a slightly

Haydar, a tall, thin male who appeared somewhat older
than his stated age, was easily engaged in the evaluation. Despite his superficially cheerful demeanor, Haydar
described himself as quite depressed, although he
acknowledged that he suffered from bouts of depression
before his arrest and detention. He reported frequently
crying and feeling irritable, particularly in the mornings.
He also described feelings of guilt and worthlessness,
blaming himself for his father’s death and mother’s
subsequent suffering. He reported frequent chest pain
(“feeling a sudden crisis in my heart”) that occurs “more
often when I’m stressed.” He also described an extreme
fear of black dogs and cats that he attributes to the dog
attacks in Guantánamo (“Whenever I see black dogs
I immediately try to get away”). Haydar also reported
having occasional nightmares in which he is attacked
by dogs. He acknowledged considerable fatigue prior to
his detention that he attributed to his marital problems,
but stated that this fatigue worsened significantly while
in Guantánamo (“I always wanted to sleep. I didn’t want
to talk to anyone. I couldn’t think about the future.”). He
was alert and oriented to person, place and time, and his
concentration was grossly intact, but his memory and
abstract reasoning abilities were somewhat limited. His
overall intellectual functioning appeared below average,
and his insight and judgment were limited.
The report prepared by the center affiliated with
IRCT revealed similarities to findings in this evaluation, including symptoms of a severe sleep disturbance
The absence of a positive diagnostic test result must not be used
to suggest that torture did not occur. See Istanbul Protocol, supra
note 7, at 42.

47  

M edical E vidence of I ll - T reatment in U S D etention F acilities   4 9

including nightmares, frequent awakenings, and a generally restless sleep pattern “crying out and crying during
sleep.” He also reported frequent chest pain, episodes of
intense anger, and headaches. Symptoms of depression
recorded included occasional tearfulness, anhedonia
(feeling estranged from others) and a diminished interest
in sexuality, memory and concentration problems, and
thoughts of suicide. The examiners at the center affiliated with IRCT also noted that Haydar had considerable
guilt related to his father’s death, along with feelings of
worthlessness about himself. He was diagnosed with
PTSD and major depression, both of which were thought
to have resulted from his own experiences and those of
his family while he was in captivity. Treatment notes indicate that Haydar was initially prescribed antidepressant
and anti-anxiety medications.
Psychological Tests:48 Haydar’s responses to self-report
measures administered were indicative of a severe PTSD
and major depressive episode far exceeding published
cut-off scores for clinically significant distress. He
further reported an extreme level of somatization and
high degree of anxiety, phobic anxiety, paranoia, and
psychotic symptoms, all of which were consistent with his
self-report. It should be noted that Haydar denied many
other symptoms, indicating that his responses were
not simply the product of indiscriminant endorsement.
Thus, these results suggest the likely presence of several
psychological disorders (depression, anxiety, PTSD, and
somatization), with no evidence of any tendency to exaggerate the extent of his symptoms.

Analysis and Conclusions
Haydar’s clinical presentation, reported symptoms, and
the results of psychological testing indicate the presence of several psychological disorders including a major
depressive episode, PTSD, and panic disorder without
agoraphobia (fear of being in public places). His description of intense chest pain accompanied by shortness of
breath and intense anxiety is strongly suggestive of a
panic disorder, although other possibilities (e.g., esophageal reflux) cannot be eliminated. It should also be noted
that although Haydar reported significant depressive
symptoms prior to his incarceration, his description of
Psychological testing included the Beck Depression Inventory, the
Harvard Trauma Questionnaire, and the Brief Symptom Inventory
and the Dot Counting Test (a clinician-administered test of symptom
exaggeration). Of note, several of the measures administered had
been previously translated and validated in his first language, with
the exception of the Harvard Trauma Questionnaire (HTQ), which was
translated by the interpreter.

48  

5 0   B roken L aws , B roken L ives

worsening symptoms during the period of incarceration
and the nature of his intrusive memories and avoidance
behaviors suggest that his incarceration experiences are
likely to have substantially exacerbated his reported preexisting psychological difficulties. This conclusion is also
supported by Haydar’s description of ongoing treatment
throughout the two and a half years in which he was
detained. His treating physicians at the center affiliated
with IRCT had concluded that he suffers from a major
depressive episode and post-traumatic stress disorder.
The physical symptoms and findings on physical
examination support his report of ill-treatment while
imprisoned. It is also important to note that many of the
beatings Haydar reported likely resulted in soft tissue
injuries and bruises that would not leave lasting physical marks. Nevertheless, the scarring on his ankles and
wrists is consistent with lengthy periods of shackling. His
report of continued back pain is consistent with being
shackled in uncomfortable positions for long periods
(e.g., bent over, chained to the floor for hours).
The evidence supports the credibility of Haydar’s
reported symptoms and experiences. His report to the
PHR evaluators was consistent with that detailed in an
evaluation prepared two years earlier by his treating
physicians in his home country. Haydar’s apparent
credibility does not, however, necessarily mean that
all aspects of his self-report were accurate. His report
may have been somewhat exaggerated, such as the
description of “a fountain” of blood spurting from his
ear, which was not supported by evidence of injury to
the tympanic membrane. It is most likely that such a
report is due to distorted perceptions due to extreme
pain and psychological distress rather than deliberate
exaggeration. There was no evidence of any deliberate
distortion or fabrications.
In conclusion, the available evidence provides strong
support for the validity of Haydar’s report of abusive treatment while in US custody, which appears to have resulted
in lasting physical and psychological symptoms that far
exceed the level of distress Haydar reported experiencing
prior to his arrest and detention.

P r o f i l e 9 : A deel 4 9
Adeel was originally detained in Pakistan in May 2002. He
was transferred to US custody at Bagram military base
and was subsequently transferred to Guantánamo. He
Adeel’s medical evaluation was conducted by Onder
Ozkalipci, MD and Christian Pross, MD.

49  

was released in the fall of 2006, approximately two years
after he was cleared to be released from Guantánamo.
While in US custody, he was subjected to a range of
abuse including prolonged isolation, stress positions,
beatings, sexual humiliation, threats, forced nudity,
religious humiliation, sleep deprivation, and food/water
deprivation. The medical evaluation reveals physical and
psychological evidence that strongly support Adeel’s allegations of ill-treatment. He is currently suffering from a
major depressive episode and PTSD.
“For two months I couldn’t sleep because there was
very strong light. We didn’t know if it was day or night.
If you fell asleep just for a few minutes they played very
loud American music, so you could not sleep.”

Background
Adeel is in his early forties. He grew up in a large family
and received a professional degree in the health field.
Adeel initially left his country to provide humanitarian
services in the midst of the refugee crisis resulting from
the Soviet occupation of Afghanistan more than a decade
prior to his detention. However, he was unable to return
home because of political problems in his country and
the persecution of his family. Some of his brothers had
been imprisoned and others had been killed. At the time
of his arrest, he was living in Pakistan with his pregnant
wife and five children and was working as a teacher for
an international organization.

Allegations of Arrest and Abuse
Adeel reported that in May of 2002, Pakistani soldiers
invaded his house at night, searching for a man of a
different name and nationality. The Pakistani soldiers
left after not finding this particular person, only to return
a couple of hours later and arrest Adeel in front of his
wife and children. Adeel reported that he was hooded and
kept for nine days in a house that Pakistani intelligence
services used as a prison. He was photographed and
fingerprinted. He was not given enough food nor was he
allowed to go to the toilet more than once a day. Adeel
recalled that other than these deprivations, the Pakistani
soldiers treated him fairly and he was not physically
abused. After nine days, the Pakistani soldiers told him
that he would be taken to Islamabad, but he, in fact, was
transferred to Bagram military base in Afghanistan.
In Peshawar airport, he and other detainees were
handed over to US soldiers. In the plane, the soldiers took
all of Adeel’s belongings, handcuffed him and shackled
his feet. Adeel reported that it was hot, and he was
hooded, chained to the floor and tightly shackled around

his chest and waist, which caused him to have difficulty
breathing. According to Adeel, the flight from Peshawar
to Bagram felt like it lasted about fifteen hours. Adeel
recalled that there were more than fifty detainees on the
plane who were all transferred in the same conditions as
he was. He recalled that the soldiers beat the detainees
if they moved and insulted them with humiliating words
that included sexual humiliation. Adeel recalled that
during the flight the American soldiers grabbed him by
the throat and threatened to choke him.
Upon arrival at the Bagram airport, all of the detainees
were tied to one rope and dragged along into a hall. The
rope was tied very tightly around Adeel’s arm, which
caused him severe pain. Soon after arriving, the detainees
were taken one by one to a small room where they were
forced to strip off all of their clothes. Adeel recalled that
if they refused, they were beaten. He reported that he
was subjected to a full body search in which the soldiers
touched his private parts and also examined his body
cavities including his anus, a treatment that he remembered as a particularly humiliating experience.
Adeel reported that at Bagram, he was never given
any reason for his detention. He was kept for two months
in a hangar in a compartment made of barbed wire and
blankets. There were between twelve and to fifteen
detainees in each compartment. “We were beaten every
day in Bagram. You cannot move. If you move, you are
punished. Punishment is suspension to barbed wire for
one to two hours,” Adeel recalled. Moreover, he reported
that he was beaten almost every day as a punishment
for talking to other detainees. He recalled: “During those
two months we were not allowed to speak any word.”
Adeel recounted that in one incident when he recited the
Koran while praying alone, the guards accused him of
having spoken to another detainee. He was beaten and
was chained to the barbed wire for several hours and
“then I was taken to interrogations.” Adeel recalled that
it was excruciating to be suspended that way since the
barbed wire hurt him when he lost his balance.
Adeel reported that the guards did not let the
detainees pray together, which he said is very important for Muslims. “They didn’t let us recite the Koran.
They threw the Koran into the toilet in front of us,” 
stated Adeel.
Furthermore, Adeel recalled that the detainees were
fed cold meals, uneatable moldy bread, cereal and
candies. In Bagram, he noted that during the first two
weeks, the detainees including himself were continuously handcuffed and had to eat while handcuffed. Adeel
recalled that some detainees remained handcuffed for

M edical E vidence of I ll - T reatment in U S D etention F acilities   5 1

several months. Moreover, he did not have a mattress
and had to sleep on the wooden floor, which was difficult
and painful.
During his detention in Bagram, Adeel reported that
he was not given a toothbrush and toothpaste. He therefore resorted to using a piece of a plastic bag to clean
his teeth. However, the detainees were not allowed to
keep any of the food packaging. He reported: “One day
the guards found a very small plastic bag of candy. I
wanted to keep it to clean my teeth. Then they beat all
the persons in the hangar.”
He recalled that the detainees were only allowed
to take showers with one to two liters of water. Adeel
noted that he and other detainees had to use communal
showers — “ten prisoners at the time had to remove
their clothes” — and he found that very shameful. Adeel
recalled: “It was not easy to use the toilet” because the
toilet was in an open space without doors. He noted that
using the toilet in an open space was very humiliating for
Muslims, and consequently many detainees, including
him, often did not eat in order to avoid using the toilet. He
reported: “[I] didn’t go [to the toilet] for five days, because
I didn’t want to go.” Adeel reported that during his detention in Bagram, he was constipated and suffered from
severe renal and abdominal pain because the detainees
were given limited water and because of his reluctance
to use a toilet in public. Following Adeel’s complaint, a
“doctor” ordered the guards to give him more water and
his pain subsided.
Adeel reported that he could not sleep because the
compartments in the hangar were lit with very strong
lights twenty-four hours per day, and loud rock music
was played all the time. He recalled that the detainees
had to sleep with their hands above their blankets or
otherwise they were punished. As a result of these conditions, he stated that he lost any sense of time, not being
able to distinguish night and day: “For two months I
couldn’t sleep because there was very strong light. We
didn’t know if it was day or night. If you fell asleep just
for a few minutes they played very loud American music,
so you could not sleep.”
Between two weeks and a month into Adeel’s detention at Bagram, the detainees were allowed one by one
to walk around inside the compartment for about ten
minutes a day. Some of the detainees including him were
never taken outside: “for two months I didn’t see the
sun,” Adeel recalled.
Adeel reported that some female guards abused the
detainees more than the men: “Females made more
problems than men. They ordered punishments. If you
5 2   B roken L aws , B roken L ives

didn’t obey, then ten [guards] would come and beat you…
We were naked several times. It was very shameful for
us.” He reported that the soldiers forcibly shaved his
beard and head three times during his detention at
Bagram. He noted one ICRC visit and that he was given
Ibuprofen by the guards.
Adeel was interrogated two times for about three
hours with the help of an interpreter. He stated that
they suspected him of having worked for Al Qaeda in
Afghanistan. He told his interrogators that he had not been
to Afghanistan in the past decade and had been gainfully
employed with an international organization. He reported
that the interrogation stopped because, he believed, they
could not confirm any of the accusations.
However, in early to mid-August 2002, Adeel was
transferred to Guantánamo. During the transfer he was
handcuffed, his feet chained to the floor and his body
shackled very tightly to his chair. He was forced to wear
a respiratory mask, black goggles, earphones with a
humming sound, and long firm “special gloves so that you
cannot move your fingers.” Adeel stated that the plane
was specifically designed for the transfer of detainees
as they sat in a row, chained to a single long seat with
their hands, legs and waist chained. Adeel recounted
that he could not move any body part except for his head
during the approximately “twenty-four hour flight.” He
recalled that the guards forced the detainees to take a
drug that made him hallucinate. He imagined that the
door of the airplane would open and he would fall out.
After about six hours, they had to change planes, and he
was dragged along by two guards. During this transfer,
somebody touched him in a humiliating manner, which
he considered the worst experience for him during those
four years of detention. Due to its humiliating nature, he
would not describe it in more detail.
Upon arrival in Guantánamo, the detainees were
forced to stand outside while being exposed to the hot
sun for five to eight hours. He asked permission to sit,
which was refused. Adeel recalled that some of the
detainees collapsed. He reported that a series of humiliating procedures similar to the one in Bagram followed:
“They made the same examination as in Bagram — a,
naked, forced anal examination. They took our pictures
without clothes,” stated Adeel. He also recalled that a
blood sample and chest X-ray were taken.
He was interrogated for approximately four to five
hours, taken to a block in Camp II, and detained in a
small isolation cell, which he described as a metal
container with a bed with sheets and blankets, and a
camping mat that was later replaced by a mattress.

Adeel reported that his cell had a sink and a toilet and
he estimated it to be about two meters in length and 1.5
meter in width. Adeel recalled, “Everything in [the] isolation [cell] was of iron.”According to Adeel, the cell was
constantly air-conditioned and very cold. When he tried
to block the air-conditioning vent with a piece of cloth,
the guards would remove it. Adeel recounted that he was
told he would be kept in such conditions and in isolation
for one month. He noted that only during food delivery
did he have the chance to exchange a few words with
other detainees.
After two weeks in isolation, he was handcuffed and
interrogated by someone he perceived to be a civilian
who spoke Arabic. Adeel believed him to be a CIA agent
based on the conversation. He recalled that this interrogator was very friendly, gave him good food, and offered
to release Adeel if he was willing to work for the US
government. If Adeel refused, the interrogator said, he
“would stay in Guantánamo all his life.” Subsequently,
Adeel was transferred to a different block, where conditions were somewhat better. He was kept in a “cage” but
could freely talk to the other detainees.
Adeel noted that six months after his arrival to
Guantánamo, he received a letter from his family via a
Red Cross representative. He was subsequently allowed
to send letters to his family every six to eight months
during the periodic ICRC visits.
According to Adeel, the detention rules prohibited
detainees from storing food in their cells. He recalled
one detainee being punished with one month of isolation
because he had kept an apple in his cell. Adeel noted that
when the detainee reported this to the ICRC, this detainee
was punished with an additional month of isolation after
the Red Cross had left the camp.
While at Guantánamo, Adeel recounted an incident
in which he refused to talk to an Arabic-speaking interrogator whom he thought was Lebanese, and he was
punished with two weeks of isolation.
Adeel reported that after two months, he was transferred to a different block in Camp I, where he remained
for seven months. According to Adeel, his conditions
deteriorated. During Ramadan, he recalled receiving
very little food that was given at ordinary meal times.
He stated that he was always hungry. The food was of
bad quality, and he noticed detainees were losing about
ten to twelve kilograms. According to Adeel, once a week
they were given a piece of meat the size of a matchbox.
They were given water that was of a yellow color and that

smelled of feces.50 Adeel avoided drinking it and subsequently got constipated and suffered from pain in the
renal (kidney) region of his back. He described that most
of the guards were very rude; they provoked the detainees,
and he witnessed that they would punish detainees with
handcuffing (shackling connecting the hands, feet and
chest), checking body cavities and touching their “private
area.” Adeel recalled that he could not sleep because the
guards were always making loud noises, stepping on and
cleaning the iron floors.
Adeel recalled that the detainees were kept in extreme
isolation in parts of the Camp Echo, including in one
area in which he was isolated for two weeks. He reported
that everybody in that camp “went crazy.” According to
Adeel, detainees were exposed to sounds and given lots
of medications and injections. After two weeks in Camp
Echo, he was taken to the interrogation room, and they
asked him to cooperate with them. Again he refused.
He reported being fearful of being transferred to Camp
X-Ray, where detainees were kept outdoors in cages,
although Camp X-Ray had been closed by that time. The
guards searched the cells with German Shepherd dogs.
He noted the dogs jumping and barking at the detainees
as a “very frightening experience.”
Adeel reported that he believed the guards planted
suspicions among the detainees by spreading rumors
that some of the detainees among them were informers,
which some men believed to be true. He stated that
every time he was transferred to a new camp, he saw
detainees whispering about him, and this made him feel
very lonely.
Adeel stated that he believed that because of good
conduct, during the last two years of his confinement he
was transferred to a more communal setting, in Camp
4. Adeel described this camp as a “luxury” compared to
the other camps. However, he recalled that there were
ten detainees and one bathroom per cell and that there
was no space for privacy. Adeel recalled that regardless
of the better conditions, he felt isolated and “bad.”
Finally, in the fall of 2006, he was released, without
any charges being brought against him. Upon his transfer
and release, Adeel recalled: “All the personal items
He was shown the color codes at the below internet link for describing
the color range of the drinking water: http://www.pitt.edu/~nisg/cis/
web/cgi/rgb.html. He responded that the color of the water changed
between the color codes: 255 250 240 up to 255 218 185. Every
time when they filtered the water with toilet paper it was still a brown
color. When asked whether he or other prisoners had suffered from
gastroenteritis or whether a gastroenteritis epidemic occurred in the
camp, he said no. He remembered the water smelled of chlorine.

50  

M edical E vidence of I ll - T reatment in U S D etention F acilities   5 3

that they had taken were not given back to me. They
[released me] with only my clothes.” Despite his release,
Adeel reported that he experiences discrimination as a
result of his detention in Guantánamo and continues to
face various obstacles to integrating back into his predetention life. He currently lives far away from his family
and is unemployed with limited prospects for changing
his situation.

Medical Evaluation

Reported Physical Symptoms
Adeel reported that, prior to his detention, he had
surgery on his nasal bone, a tonsillectomy and a duodenal
ulcer, for which he was treated and had no complaints
thereafter. Apart from that, he reported that he was a
healthy man prior to his arrest and detention. However,
currently he suffers from various health problems.
Adeel reported that since his detention in Guantánamo,
he has been suffering from back and knee pain; he
explained that his knee was swollen, and he was given
anti-inflammatory drugs in Guantánamo. Currently,
when he stands up, he hears a cracking sound in his
knee that he attributed to not having been allowed to
move in Bagram, to having been kept in painful stress
positions on the floor in Guantánamo, to having been
forced to sleep on a metal bed, and having been kept in
“iron cages” with cold air conditioning. He reported that
after his release, he could not move and continues to
suffer from pain in his hip joint and back.
Adeel reported that in Guantánamo, he was diagnosed
with tuberculosis and was given isoniazid and vitamin B6.
According to Adeel, he recovered just before his release.
Since his detention in Bagram, he reported having
suffered from constipation; he can only go to the toilet
two to three times a week. He stated that he often had
gastric pain for which he was sometimes given drugs like
“Librax.” He has had stomach problems with epigastric
pain, which is associated with a bad taste in his mouth
in the morning and exacerbated when he eats butter, oil
or spicy food.
While in Guantánamo, he got fungus on his feet and on
the axillary (armpit) area and attributes this to the fact
that the detainees did not have personal overalls and
their clothes would get mixed up when they would return
from the laundry. In the last two years of detention his
skin turned dark on the left abdominal region. He used
antifungal medication, which did not help.
Since his early days in Guantánamo, Adeel reported
sometimes having ear pains that, despite his requests,
were not examined; nor was he given any medication.
5 4   B roken L aws , B roken L ives

Adeel reported that while in detention, twelve of his
teeth began to rot. He attributed this to not having a
toothbrush and only using “bad toothpaste.” He did not
seek to see a dentist since he feared that the dentists
would remove his teeth instead of repairing them.

Assessment of Physical Evidence
The physical examination revealed several findings consistent with Adeel’s allegations of torture. For
example, the diagnoses of otitis externae (inflammation
of the outer ear canal) and atrophic tympanic membrane
(thinning of the eardrum) are consistent with his allegation of eardrum perforation as a result of beatings
with subsequent secondary infection. The neurological examination of Adeel showed no neurological and
pathological signs. Constipation can occur secondary
to stress conditions and can result from inadequate
intake of fluids and food and restrictions on mobility. The
chronic constipation Adeel reported also may represent
a psychosomatic manifestation of several forced anal
cavity searches and a physical response to the detention conditions he reported.
Adeel had demonstrated gingival (gum) recession
and absence of teeth which is highly consistent with
Adeel’s report of poor hygiene and health conditions in
detention. Adeel had demonstrated vertebral abnormalities. Spondyloarthrosis51 and discopathy52 at the
level of the second and third lumbar (L2-L3) vertebrae
is consistent with his reports of long-lasting restriction of movements and physical trauma during detention. He experienced pain in right knee movements
which is consistent with restriction of movements
and reported knee trauma. However a dermatological expert opinion is needed to determine whether
the darkening of the skin in the abdominal region is
an after-effect of some kind of chronic intoxication
by chemicals used for sanitary purposes or other
substances applied during detention or post-inflammatory change after a fungal infection. Moreover, an
orthopedic expert opinion and bone scan would aid
in the detection of signs of non-visible soft tissue and
bone injuries by beatings.
Medical Tests: Laboratory tests showed a normal
blood count and normal blood chemistry results with
the exception of an elevated hepatitis B antibody level
(24 mU/ml) indicating exposure to the hepatitis B virus.
A complication from degeneration of the vertebra and intervertebral disks. Osteophytes, or bone spurs, form about the degenerating
tissue which may, in turn, compress spinal nerves.

51  

52 

Refers to disease of the intervertebral disks.

Because Adeel does not remember any vaccination of
hepatitis B, it may be the result of a past hepatitis B
infection.

Assessment of Psychological Evidence
Adeel reported that there is no history of psychiatric
disorders in his family. He described feeling helpless,
desperate, devastated, destroyed and very confused
during his detention. Recalling his darkest moments while
in detention, Adeel remembered thinking that “Satan”
tempted him to commit suicide. But he said he adhered
to Islamic rules. He stated that he was in constant fear,
felt threatened and was always on the alert and under
stress. He had palpitations and sweated profusely. He
sometimes heard people speaking about him and then
realized that he had only imagined it. He realized that he
was hallucinating, which made him afraid that he was
going “crazy.”
Adeel stated that he currently feels that this traumatic
experience has transformed him into a different person,
and he no longer has a strong will: “I have lost all my life,”
he noted. He reported feeling lonely, isolated and abandoned. He stated that he does not have a job and lives far
from his family or anyone with whom he can communicate and share his problems. He stated that he only lives
with a small subsidy. He mentioned that he misses his
family terribly and that he is afraid of the future. “I feel
like I am in a big prison and still in isolation.”
He reported having nightmares of Guantánamo that
force him to wake up in the middle of the night, and not
being able to go back to sleep because he ponders his
misery. He reported starting to panic when somebody
walks behind him and that he often feels people are
looking at him, which makes him think that he is not
normal. He stated that he is nervous and he gets irritated
about minor problems. Adeel reported that he sometimes suffers from blackouts and he has lost some of his
memory capacity. He cannot remember the Koran very
well, and he has no desire to read like he did before.
Adeel reported that he generally mistrusts and is
afraid of people unlike before. He stated that he avoids
making friends and does not want to talk to anybody. He
said that his view of the world has changed for the worse.
He is haunted by the bad memories from Guantánamo
every day, and he avoids people with uniforms when he
is in the public. He reported that he avoids thinking about
his situation in order not to bring back bad memories.
However, his solitude and overall situation make it difficult for him to distract himself from thinking about these
traumatic experiences.

Psychological Tests:53 On the self-report measures
administered, Adeel reported numerous symptoms of
PTSD, anxiety, somatization, and depression. Adeel’s
responses to the Dot Counting Test, a clinician-administered test of symptom exaggeration, indicated that
he responded honestly with no evidence of deliberate
exaggeration.

Analysis and Conclusions
Adeel demonstrated historical, physical, and psychological evidence that strongly supports his allegations
of ill-treatment.
Adeel suffers from chronic constipation. This symptom
may be an after-effect of forced body cavity searches and
physical response to detention conditions given the level
of psychological trauma associated with his experiences.
Evidence of eardrum perforation and chronic outer-ear
infection is consistent with Adeel’s history of beatings to
the head. He suffers from inflammation of the gums and
loss of teeth likely due to poor hygiene in detention. He
was diagnosed with Spondyloarthrosis and discopathy at
the level of second and third lumber (L2-L3) vertebrae
and suffers from chronic pain of his knees and joints
that is consistent with Adeel’s history of restricted movements, prolonged exposure to cold temperatures and
being shackled in painful positions for long periods of
time. He also suffers from chronic gastritis. Considering
that there is a pre-detention history of duodenal ulcer,
his gastric complaints are most likely due to a preexisting ulcer disease and likely have been aggravated and
become chronic because of detention.
Based on the self-report, Adeel suffered from transitory psychotic episodes that were likely due to longterm isolation in Guantánamo and the effects of the
medications he received. Presently there are no signs
of psychosis. The results of psychological testing and the
clinical findings support the presence of several psychiatric diagnoses including major depressive episode and
post-traumatic stress disorder. He suffers from intrusions, avoidance behavior and hyperarousal. He is
constantly haunted by the memories of trauma; he avoids
triggers that remind him of Guantánamo; and he has
sleeping problems. He suffers from irritability, startle
response, inability to concentrate, and memory loss. He
is hypervigilant and has lost trust in people. All these
symptoms confirm the diagnosis of PTSD. Additionally
Psychological testing included the Beck Depression Inventory, the
Harvard Trauma Questionnaire, and the Brief Symptom Inventory
and the Dot Counting Test (a clinician-administered test of symptom
exaggeration).

53  

M edical E vidence of I ll - T reatment in U S D etention F acilities   5 5

he feels hopeless and sees no future for himself. He has
lost his energy and he isolates himself from people, all
symptoms that support the diagnosis of depression.
Adeel’s condition is particularly aggravated by the fact
that he lives in social isolation, is unemployed, below the
poverty line, and cut off from his family. He has virtually no opportunity for building a new life or finding a
job. In addition, he does not have access to health care
and psychological support services. Accordingly he
sees his current life as an extension of his detention in
Guantánamo.
In conclusion, the physical and psychological evidence
demonstrate that Adeel is suffering from considerable
physical and psychological pain as a result of his arrest,
incarceration and ill-treatment.

P r o f i l e 1 0 : Y oussef 5 4
Youssef was originally detained at the border of Pakistan
in late 2001 or early 2002. He was held by US personnel
at Kandahar and Guantánamo Bay detention centers.
He was subjected to beatings, electric shocks, sleep
deprivation, and sexual and cultural humiliation. He
was released in November 2003. The medical findings
indicated that Youssef is suffering from a major depressive episode, moderate PTSD, and panic disorder without
agoraphobia.
“[In Kandahar] as soon as we landed they started
hitting us — some of them were hitting us with sticks,
and some of them were punching us, and some of them
were kicking us, and when we were on the ground
some of them were kicking us between the legs.”

Background
Youssef, a male in his early forties, grew up in a large family.
His father was a factory worker. His family often suffered
from financial difficulties and illness. One of his brothers
developed leukemia, and another had a physical disability.
He described being raised as an observant Muslim.
Youssef attended school until the age of eighteen but
dropped out because of his family’s financial difficulties. He had problems finding work in his home town
and eventually moved to another city where he found
occasional employment as a construction worker. Later,
he delivered water and medical supplies to refugees for a
local charity. Still unable to meet his financial needs after
several months, Youssef decided to travel with a friend to
Youssef’s medical evaluation was conducted by Allen Keller, MD and
Barry Rosenfeld, PhD.

54  

5 6   B roken L aws , B roken L ives

Afghanistan in early 2001. He recalled that he was “told
by a friend that my life would be better there — and I
guess I believed him.” After he arrived, he quickly learned
there was little hope for employment in Afghanistan, but
said he could not leave because his friend had taken
his passport to get him a work visa. After the US war in
Afghanistan began, he decided to leave Afghanistan via
Pakistan and return to his home country.

Allegations of Arrest and Abuse
Youssef recalled being detained at the Pakistani border in
late 2001 or early 2002, while trying to cross the AfghanPakistan border without his passport. He requested
access to his home country’s authorities but was placed
in a Pakistani prison for nearly two months where he
experienced harsh treatment (legs shackled constantly,
no ability to bathe, and little food). While in Pakistani
custody he was interrogated by “the Americans” and,
eventually, was transferred to a US prison in Kandahar,
Afghanistan. During his transfer, he was hooded, making
it difficult to breathe, and was shackled to the floor of
the plane with his hands tied behind his back. He was
never informed of where he was being taken or why and
realized he was in US custody only when the bag was
removed from his head in Kandahar.
Youssef reported, “As soon as we landed [at Kandahar]
they started hitting us — some of them were hitting us
with sticks, and some of them were punching us, and
some of them were kicking us, and when we were on
the ground some of them were kicking us between the
legs.” He related that the initial assault lasted for three
to four hours and was extremely painful, although he
suffered no serious injuries at the time. He also stated
that he had difficulty urinating for the first “one or two
weeks” after this assault, presumably from groin injuries. Youssef noted that he was interrogated during this
initial encounter but stated that he did not understand
the questions because he did not speak Arabic and only
recognized the word “Taliban.”
Youssef recalled that after his interrogation, soldiers
stripped him naked. He noted that many of the soldiers
were female and he believed that “they were just trying
to humiliate us.” He was allowed no sleep during his first
night in Kandahar because the guards “kept kicking us
[and] throwing sand at us.” Throughout his roughly six
weeks in Kandahar, he endured other abuse, including
being stripped naked, being intimidated by dogs, being
hooded, and being thrown against the wall on repeated
occasions. He did not lose consciousness during these
assaults. He also recalled having been subjected to

electric shocks once by purposefully being pushed into
a generator and described feeling “as if my veins were
being pulled out.” He was threatened with electric shock
on other occasions, but was shocked only that one time.
With the exception of persistent wrist pain, he denied
any lasting physical injuries from the beatings or the
electric shock.
Youssef was subsequently transferred to Guantánamo
in early 2002. He recalled that he was forced to disrobe
in front of female soldiers, was clothed in an orange
suit and dark goggles, and his ears were covered with
headphones. He stated, “They didn’t tell us anything — I
remember the plane and the doors opening and there
was warm air.” He stated that he was unsure how long
the flight lasted “but it felt like 24 hours.” Youssef added
that he was handcuffed and shackled to the floor of the
airplane throughout the trip and noted, “We had those
cuffs on for a very long time … and they tightened up the
cuffs on the plane and my hands started swelling up.”
Youssef injured his leg when he slipped and cut
his leg on a piece of metal while being transported to
Guantánamo, but reported that it was not the result of
ill-treatment. He stated before being taken to “Camp
X-Ray,” he was again stripped, sprayed with water and
superficially examined by a doctor looking for wounds or
broken bones (“They just asked if I had any pain … I told
them about my foot — and they took a blood sample and
a hair sample, and they took saliva.”).
Youssef described the conditions at Camp X-Ray as
deplorable: “It was just a big plot of concrete and they had
these steel cages [and] it was really, really hot…even in
the night.” The prisoners were let out of the two-squaremeter “cages” only for questioning, were not allowed to
speak to each other, and had to use a bucket as a toilet.
Even small infractions could result in beatings. “If they
would find one piece of string on the floor they would
send in the ‘robocops’ [the IRF soldiers dressed in riot
helmets and padded uniforms] to beat us.” The detainees
were kicked all over, including in the back, legs, and
head. According to Youssef, during the two to three times
that he was beaten this way in Camp X-Ray someone
who he presumed to be a doctor was always present; he
suspected this was to make sure there were no injuries.
Youssef suffered bruising as a result of these beatings
and did his best to follow prison rules in order to avoid
such abuses. However, he witnessed other detainees
being beaten this way on a daily basis.
In other incidents, he recalled, “the robocops” would
enter his cell, forcing him to sit on his knees with his
hands pressed together behind his back or head; or

forcing him to lie on the floor with his hands behind his
back and tied to his feet, forcing his legs to lift up. He
stated that he was forced to maintain these stress positions for up to an hour.
He noted that he was provided adequate food and
water in Camp X-Ray (“Compared to normal daily intake it
wasn’t enough, but we survived on it — it was bearable”).
He reported frequent sleep deprivation and fatigue due to
lengthy interrogations and the guards disrupting his sleep
whenever his hands or feet were under the blanket.
After the first few weeks at Camp X-Ray, conditions
improved slightly. Youssef and the other detainees were
no longer beaten for speaking to each other, and he was
allowed out of his cell at noon “to go to the bathroom”
and for weekly showers, in addition to for occasional
interrogations.
Youssef was transferred to Camp Delta with other
detainees after approximately three months. He
described the overall conditions at Camp Delta as
better than those at Camp X-Ray. The camp had been
built recently and included toilets and running water
in the cells. The detainees were allowed to speak with
each other; they were still confined to their two-squaremeter cells, however, and let outside to exercise only for
about fifteen minutes once a week, although this later
increased to two and even three times per week.
Youssef reported that he was sometimes beaten by the
IRF guards after interrogations and for infractions like
hiding food in his cell. Once, following an interrogation,
the chains on his wrist were pulled, causing him severe
pain. He also recalled that the guards “would come with
a spray and spray us in the eyes” causing severe pain.
(“My whole body would feel like it was burning — not just
my face, but my whole body, and it felt like they had filled
my eyes with sand. And sometimes I felt like I was losing
consciousness from the burning.”) He noted that he “felt
very dizzy and…I felt it very hard to breathe.”
Apart from following interrogations or beatings, and
despite his frequent requests for medical attention
(“many, many” requests) for persistent stomach pain
and swelling in his wrists, Youssef noted that he rarely
saw physicians at Guantánamo. He was of the opinion
that no one was concerned with the detainees’ health
and recalled having been told by one of the physicians,
“We’re making sure you don’t die in here — besides that
whatever happens doesn’t interest us.” Youssef reported
that he was forced to take medications as part of what
he considered “experiments” and recalled receiving
an estimated ten to fifteen unknown injections, often
developing rashes several hours after these injections

M edical E vidence of I ll - T reatment in U S D etention F acilities   5 7

(“red dots on my body and shoulders that would start
to itch”). A fellow detainee informed him that the injections could cause impotence or heart attacks, although
nothing was ever said by the doctors. He also indicated
that some individuals administering the injections were
“civilians … coming to take lessons — it was like internships” but acknowledged that this may only have been
his perception.
Youssef stated that he was interrogated almost every
other day while at Camp Delta. Although he was not
subject to any physical assaults while being interrogated,
some of his most painful experiences at Guantánamo
occurred while being held in the interrogation rooms.
He recalled being held in extremely hot or cold interrogation rooms for extended periods of time (“forcing
us to sit chained for eighteen or twenty hours”); sometimes ice cold water was poured over him. He added
that “sometimes they were playing very loud music” that
was painful, although he denied sustaining any hearing
damage. During the lengthy interrogations, he was not
allowed to use the toilet or pray and described experiencing significant back pain from the extended forced
sitting. He recalled “physicians” participating in these
interrogations and occasionally checking on him; he
thought their job was to determine whether the abuse
could continue. He acknowledged, however, that he
was unsure of precisely what was said between those
he perceived to be the doctors and the soldiers, only that
the abuse always continued (“The doctor was working
with [the soldiers]”).
While in Camp Delta, Youssef asked to speak with a
psychologist because he was distressed, and the two
spoke about him missing his family and his feelings of
sadness. Although Youssef believed the meeting was
confidential, he stated that shortly after the psychologist
left, he was brought to an interrogator who immediately
brought up information connected to his disclosures, such
as telling him that he was going to stay at Guantánamo
for the rest of his life and discussing his family (“Don’t
you want to leave this place and get back together with
your family?”...If you do as we tell you, you can get back
to your family.”). He stated, “I figured out the reason
they had called me for the interrogation was because
the psychologist had told them about the meeting.” He
stated, “They were stressing these fears very much.”
Following this interrogation, Youssef reported that he
was moved to the “worst” section in Camp Delta, where
he was not allowed to have a blanket or a mattress.
Youssef also described a number of experiences that
were extremely upsetting and humiliating. He reported
5 8   B roken L aws , B roken L ives

being forced to look at pornography and to witness naked
men and women appearing to have intercourse. He also
described an incident in which a woman entered the interrogation room naked and smeared what he perceived to
be menstrual blood on him, which he described as horrifying. He also witnessed soldiers desecrating the Koran,
ripping it apart or writing offensive words on the pages,
and occasionally throwing the Koran in the toilet or deliberately stepping on it. He also stated that the soldiers
in Camp Delta loudly hit the cell bars with sticks when
the detainees were praying. Youssef also said he was
threatened by guards during interrogations, including
threats that he would be shot. Interrogators claimed
that his fingerprints had been found on weapons and
that his name was in documents found in Afghanistan.
They also claimed that his brother with leukemia had
been arrested. He stated that he was asked to confess
to both fighting against the United States and being part
of al Qaeda or the Taliban. He was told that he would be
released if he confessed to these accusations.
Youssef was transferred out of Camp Delta to another
location that he referred to as “Camp Four.” He explained,
“It was better — generally they were saying that people
who were sent there would eventually leave.” He received
medical attention for his stomach pain, headaches,
and other problems (e.g., feet and eye problems), but
added that, “They never treated anything.” However,
he acknowledged that “When I first got [to Camp Four
I thought] I was about to die, because of the change in
temperature [in the interrogation room] — that’s when
they gave me saline.” He stated that he was eventually
returned to Camp Delta for another few days and told that
if he signed a statement he would be released. He stated
that he agreed to sign this form because “I was already
under so much pressure.” He was released in November
2003 without any charges being brought against him. He
was then handcuffed, chained to the floor of an airplane,
and returned to his home country.
Upon arrival at his home country, Youssef was detained
by the local police but “was taken to court and I was
set free.” He noted that, in contrast to his detention at
Guantánamo, the local authorities “were very civilized.”
Youssef reported that he has had difficulty functioning
since his release and has not been able to find steady
employment, in large part due to his psychological problems. As soon as he returned to his home country, he
served fourteen months of mandatory military service,
where he spent most of the time in a psychiatric hospital
ward because he was labeled “too aggressive” and
“was not treating people above me the way I should

have been.” At the time of the evaluation, Youssef was
unemployed and volunteering part-time for a refugee
aid organization.

Medical Evaluation

Assessment of Physical Evidence
Youssef denied having any significant medical problems prior to his imprisonment. He reported, however,
that since his release from Guantánamo, he has felt
chronically tired and weak. He did not mention any
persistent back or muscle aches at the time of his evaluation, although he reported severe pain while in custody.
He underwent surgery on both wrists to alleviate chronic
pain caused, he believed, by the extended time he spent
in handcuffs. Nonetheless, he noted that he has experienced renewed pain in his right wrist. Youssef added that
he has continued to experience stomach pain that began
while incarcerated. He also described frequently experiencing bitemporal headaches radiating to his eyes that
last two hours or more and are relieved with pain medication. Youssef reported some difficulty breathing out of
the right side of his nose, but was unsure of the cause or
when it started. He also reported “trouble with my heart
— it feels trapped, but when I went to the hospital and
had various checks done, nothing was diagnosed — but
I know it contracts.”
Several significant findings were noted during Youssef’s
physical examination. His nose is slightly deviated to the
left, but this deviation is of unknown origin. He also has
tenderness in the muscles of his right wrist with extension. There is an area on the lateral posterior aspect
of Youssef’s left wrist with atrophic (i.e., thinning of the
skin) changes and decreased hair, which he attributes to
handcuffs rubbing against his skin. Well-healed vertical
surgical scars are evident on the back of both wrists.
A scar on his left ankle with slight atrophic changes is
attributable to the injury he sustained while getting into
a truck during his transfer to Guantánamo. Youssef has
several other dermatologic findings, which he reports
are unrelated to his imprisonment and is unsure of
their etiology.
Medical Tests: A bone scan showed increase focal
activity of both shoulders consistent with degenerative
arthritis. Nasal bone X-rays showed deformation of the
former detainee’s nasal bone with deviation to the left,
which is highly consistent with a history of trauma.

Assessment of Psychological Evidence
Youssef was quiet and reserved, with little emotional
expression in his voice or demeanor. He recounted having

many friends before his incarceration but has become
more isolated since his release from Guantánamo. He
acknowledges that prior to his imprisonment, his family
problems distressed him, resulting in some sleep difficulties, diminished appetite, lack of energy, and periods
of tearfulness. He attributes this state mostly to feelings
about his brother’s leukemia and not being able to help
his family financially. While these symptoms were present
when he was arrested, they worsened over the two years
of incarceration. He described that after his release
he has been “constantly sad” and noted that he cries
periodically but less often than in the months following
his return. He stated that he is usually lonely and is no
longer able to feel happy; instead he feels irritable and
short-tempered much of the time (“Nothing makes you
happy — sometimes the most natural events will make
you angry.”). He denied sleep difficulties at present, but
reported frequent past nightmares and dreams of being
re-arrested. He also described feelings of guilt and hopelessness, feeling as if he has no future. He described
himself as fatigued (“I feel like I never get enough sleep”)
and reported having difficulty getting out of bed. He also
described feeling very uncomfortable whenever he sees
military personnel or people wearing orange clothing
(the color of his Guantánamo uniform).
He described being easily startled by loud noises and
avoids places and interactions that remind him of his
detention experiences. He cited this avoidance as one of
the reasons why he left his home and is currently living
in another city, i.e., to avoid discussing his experiences
with his friends and family. He noted that he experiences periodic “heart problems” in which “my heart
feels trapped.” He explained that he has shortness of
breath and frequent stomach pains, but does not experience numbness in his extremities or amnesia. When
asked about his smoking, he acknowledged his intake
increased dramatically, from only a few cigarettes per
day before his detention to roughly half a pack per day
at present. He acknowledged having a short temper, but
denied suicidal or homicidal ideation and denied auditory
or visual hallucinations. However, he revealed considerable paranoid ideation, both related to his detention
experiences (e.g., believing that doctors were “experimenting” on him) and at present (e.g., feeling as if the
government is monitoring his activities, feeling that he is
being followed in the streets).55 He was alert and oriented
It must be noted that there may be some legitimacy to Youssef’s
suspicions. His perception that psychologists were complicit in interrogations and conveying his confidential information to interrogators
is consistent with the well-documented role of psychologists in the

55  

M edical E vidence of I ll - T reatment in U S D etention F acilities   5 9

to person, place and time, and his memory and concentration were grossly intact but his abstract reasoning
abilities were limited. His overall intellectual functioning
appeared approximately average, and his insight was fair
and his judgment was intact.
Psychological Tests:56 On the self-report measures
administered, Youssef reported a number of test items
indicative of depression, anxiety, and PTSD, all of which
were consistent with his self-report. He demonstrated
symptoms of severe PTSD, far exceeding the established
cut-off for identifying individuals with clinically significant distress. However, his responses to measures of
depression suggested the presence of numerous depressive symptoms but likely not of the magnitude of a major
depressive disorder. Youssef also endorsed a number
of physical symptoms that are typically attributable to
psychological causes (e.g., dizziness, nausea, numbness,
stomach pain). Although the latter symptoms cannot be
conclusively attributed to psychological, rather than
organic causes, the possibility that these symptoms
reflect a somatization disorder certainly exists.

Analysis and Conclusions
Youssef’s clinical presentation, reported symptoms, and
the results of psychological testing indicate the presence of several psychological disorders including a major
depressive episode,57 moderate PTSD, and panic disorder
without agoraphobia. Specifically, Youssef described a
interrogations at US-run detention facilities. See M. Gregg Bloche
& Jonathan H. Marks, Doctors and Interrogators at Guantánamo Bay,
353 New Eng. J. Med. 6 (2005). Further there have been numerous
other allegations of experimental forced injections including for
the purpose of interrogations. See Joby Warrick, Detainees Allege
Being Drugged, Questioned: U.S. Denies Using Injections for Coercion,
Wash. Post, Apr. 22, 2008, at A1, available at http://www.washingtonpost.com/wp-dyn/content/article/2008/04/21/AR2008042103399_
pf.html. Psychological testing included both self-report measures
of symptom distress (the Beck Depression Inventory, the Harvard
Trauma Questionnaire, and the Brief Symptom Inventory) and the
Dot Counting Test (a clinician-administered test of symptom exaggeration). Of note, several of the measures administered had been
previously translated and validated in his original langue, with the
exception of the Harvard Trauma Questionnaire (HTQ), which was
translated by the interpreter.
Psychological testing included both self-report measures of
symptom distress (the Beck Depression Inventory, the Harvard
Trauma Questionnaire, and the Brief Symptom Inventory) and the
Dot Counting Test (a clinician-administered test of symptom exaggeration). Of note, several of the measures administered had been
previously translated and validated in his first language, with the
exception of the Harvard Trauma Questionnaire (HTQ), which was
translated by the interpreter.

56  

A major depressive episode is not a disorder in itself, but rather
is a description of part of a disorder, most often major depressive
disorder.

57  

6 0   B roken L aws , B roken L ives

number of symptoms of depression that, while present to
a lesser extent before his arrest and extended incarceration at Guantánamo, appear to have become pronounced,
disabling, and chronic since his detention. His PTSD
appears to have persisted throughout the three years
since his release from custody. Youssef’s description
of “heart problems” and shortness of breath, with no
identifiable medical etiology, is strongly suggestive of a
panic disorder. It should be noted that although Youssef
reported depressive symptoms prior to his incarceration,
the timing of Youssef’s reported symptoms and nature of
his intrusive memories and avoidance behaviors indicate
that the incarceration directly caused and/or exacerbated
his psychological difficulties.
The physical symptoms Youssef described and the
findings on physical examination support Youssef’s
reports of ill-treatment while imprisoned. Many of his
scars are consistent with his described ill-treatment
(e.g., being dragged while being handcuffed, beatings).
Many of the beatings Youssef reported likely resulted
in soft tissue injuries and bruises, which would not
leave lasting physical marks. His report of headaches is
certainly consistent with the history of head trauma he
reported, although the possibility of a more psychogenic
etiology of these headaches also exists. Likewise, his
report of frequent stomach pain may be the result of a
peptic ulcer disease or gastritis, but could also reflect
a somatic manifestation of his psychological distress.
Other findings appear clearer, such as the increased
activity in both shoulders observed on the bone scan,
which is consistent with degenerative arthritis. Given his
young age, these findings are likely to have resulted from
being forced to maintain uncomfortable arm positions as
he described. The findings on a nasal bone X-ray film of
a deformation of the nasal bone with deviation to the left
are consistent with a prior history of trauma.
The available evidence strongly supports the credibility of Youssef’s reported symptoms and experiences.
Youssef was forthcoming in describing which symptoms
have continued as well as those that have resolved. He
was also forthcoming in describing what he experienced,
including stating that he did not personally experience
certain abuses reported by others. Furthermore he
readily acknowledged that many of the scars noted on
physical examination were unrelated to his imprisonment and ill-treatment and acknowledged considerable
psychological distress prior to his arrest. Moreover,
psychological testing suggests that Youssef responded
honestly to the psychological tests, with no evidence of
any deliberate exaggeration.

Youssef’s apparent credibility does not, however,
necessarily mean that all of his perceptions and interpretations were accurate. For example, his description
of medical experimentation and involvement in forced
experiments may reflect a paranoid interpretation of
events. Such a paranoid interpretation of ambiguous
events is consistent with the presence of PTSD, as individuals typically become hypervigilant with a heightened
expectation of additional ill-treatment. His perception
that the treating psychologist had conveyed information
to the individuals who subsequently interrogated him
seems plausible and convincing because of credible,
independent reports that the Guantánamo Behavioral
Sciences Consultant Teams had access to detainees’
personal health information.58 On the other hand,
Youssef’s perception may reflect a heightened sensitivity to ill-treatment that often results from exposure
to traumatic abuse (i.e., torture). Youssef may also have
made mistaken assumptions about the identity of various
personnel he encountered; for example, it may be that
medics or nurses were present at interrogations or beatings, not physicians.
In sum, the available evidence provides strong support
for the validity of Youssef’s reports of abusive treatment while in US custody. In turn, this abusive treatment appears to have resulted in lasting physical and
psychological symptoms that far exceed the mild level of
distress Youssef reported experiencing prior to his arrest
and detention by the United States.

P r o f i l e 1 1 : R asheed 5 9
Rasheed was originally detained in Afghanistan at the end
of November 2001. He was held by US forces at Bagram,
Kandahar, and Guantánamo. He was subjected to a range
of abuse including prolonged isolation, sensory deprivation, forced nudity, beatings, various injections, unwanted
medical procedures, forced shaving and exposure to cold
temperature and loud noises. In the fall of 2006, Rasheed
was released from Guantánamo. The medical evaluation
reveals a wide range of physical ailments due to injuries
endured during detention. He is currently suffering from
complex PTSD and somatization disorder due to severe
sequential traumatization by US forces.

58 

“I am not the person I used to be. I have lost my kind
attitude to people,. I lost my nerves. I have turned
[completely].”

Background
Rasheed is in his mid-thirties. After he finished high
school, he attended a center for scientific research and
became an engineer. He is married and has two young
daughters. He lost two sons when they were infants.
He converted to Islam in the mid-1990s. A few years
later, when he refused to shave his beard and renounce
his religion, he lost his job at a company as a result of
his government’s anti-Islamic stance. He then made a
living by repairing audio players and working as a private
construction worker. In 2000,60 the police of his home
country arrested him and held him on assertions of
terrorism. While in custody, Rasheed was badly beaten
on his head, back and abdomen. He reported that he lost
consciousness, vomited and had blood in his urine.
Rasheed recounted that after his release, he was
told by government officials that he either had to leave
the country or he would be taken to prison. He fled his
homeland in early 2001, and was forced to live in a transitory refugee camp in another country for four months.
Rasheed reported that, because he did not have proper
legal documents, government officials of the country in
which he had sought refuge then flew him out of that
country and into Afghanistan where he resided until the
war began. In Afghanistan, he worked in various jobs,
including as an engineer on the lighting system of a
local mosque.

Allegations of Arrest and Abuse
At the end of November 2001, when the US war in
Afghanistan began, the members of the village in which
Rasheed resided fled into the mountains where they
stayed for a few months. Rasheed reported that one
day, members of the village were stopped by bandits.
He was abducted by the bandits, who sold him to US and
Northern Alliance troops who were searching for insurgents and “offering $3000 for a captured insurgent.”
In April 2002, he was taken to Kunduz, Afghanistan
in handcuffs, with his eyes covered with goggles. His
clothes were cut off and his body was searched, including
“impossible” places. Rasheed recalled that he was
beaten and remained confined and naked on a concrete
floor. Because he was not allowed to go to the toilet, he

Bloche & Marks, supra note 55, at 6-8.
Rasheed reported to the evaluators that he was arrested in November
2001 by authorities in his home country. However, his date of arrest
has subsequently been confirmed to be August 2000.

60  

Rasheed’s medical evaluation was conducted by Onder
Ozkalipci, MD and Christian Pross, MD.

59  

M edical E vidence of I ll - T reatment in U S D etention F acilities   6 1

recalled that he “defecated on the floor and spent the
night in [my] feces.”
In May 2002, Rasheed recalled being taken to Mazari-Sharif where he was beaten severely to the point of
unconsciousness. Rasheed noted that when he woke up,
he felt pain under his ribs, over his kidneys and in the
area of his liver, and had blood in his urine. After three
days, he was transferred by airplane to the military base
in Bagram.61

Bagram and Kandahar Prisons, Afghanistan
Rasheed reported that he was beaten by US soldiers
during his transfer by plane to Bagram. He recalled
that he stayed fourteen days in Bagram, where he was
put in a cage and was interrogated over long periods of
time. During the first two lengthy interrogations, he was
not beaten; he was only hooded. During the third interrogation, he reported that he was hooded, repeatedly
beaten by blows and kicked in his abdomen. As a result
of the beatings, his head struck the ground and he lost
consciousness.
When he woke up, he found himself in a clean room. He
had a painful large swelling in his right lower abdomen.
He recalled asking to see a doctor. Someone whom he
perceived to be a doctor subsequently took blood and
urine samples. Rasheed recalled that at that point he
“wanted to die” because of the intense pain. However,
against his will, Rasheed was held down by force and
was given an unknown injection. He recounted that he
woke up in a military hospital after having had a medical
procedure without his consent, without information about
the type of procedure, and against his wishes. Rasheed
was told the swelling was not his appendix, but the nature
of the operation was not disclosed.62
Rasheed recounted that while he was hospitalized he
was handcuffed and tied to the bed with a leather strap.
Rasheed recalled that his pain and the swelling remained
present. When he was released from the military hospital
after four days, two soldiers had to carry him because
he could not move on his own.
Soon after his surgery, the Americans transferred
Rasheed to Kandahar. During the flight, although he
was in very bad health and only recently had undergone
the operation described above, he was hooded, and his
hands and feet were shackled and tightly tied together.
Rasheed did not identify the perpetuators of the abuse he endured
before being transferred to US custody in Bagram (i.e., while being
detained in Kunduz or transferred to Mazar-i-Sharif).

61  

Rasheed’s Guantanamo medical file noted that he had an inguinal
hernia repair in Bagram.

62  

6 2   B roken L aws , B roken L ives

Rasheed recalled that his knees were tied in a kneeling
position by adhesive tape. In this painful position, he was
tied to the floor and was unable to move.
Upon arrival in Kandahar, Rasheed recounted that
the US soldiers cut off all his clothes and stripped him
naked. His hands and legs were in shackles and he was
forced to wear goggles and earphones that prevented him
from seeing and hearing. He was tied to a table with his
hands behind his back. Rasheed reported that female
soldiers sat on the detainees, took photographs, beat
them on the head, and humiliated them by laughing and
offending their religion.
After approximately two hours, Rasheed reported
that the American soldiers tied him and the other
detainees together with a rope and dragged them about
200 meters along a rocky pathway. He recalled that
when he screamed because of the ongoing pain in his
abdomen, the soldiers pushed his face forcefully down
on the ground. The detainees were brought into a tent,
where it was extremely hot; he felt it to be approximately
100 degrees Fahrenheit. Rasheed recounted that he was
kept in the tent for about twenty days; he felt very sick.
For the first seven to nine days he couldn’t eat anything
and requested to see a doctor. The soldiers told him they
did not have a doctor. At that point, the swelling in his
abdomen was “the size of half an orange,” and its color
had become black and blue. Rasheed noted that it took
more than six months for him to recover fully from the
pain and the swelling in his abdomen, and he received no
medical treatment for his condition during that time.
Rasheed described that during his detention in Kandahar,
he was unable to sleep because the soldiers played loud
US rock music all the time. Rasheed also reported that
the soldiers would unleash dogs on the detainees.

Guantánamo Bay
In early summer of 2002, after he had been in
Kandahar for approximately one month, the guards
shaved Rasheed’s head and beard and transferred him
to Guantánamo. During the cross-Atlantic flight he
approximated as “twenty-two hours,” he recalled that
he was shackled, his hands were fixed in stiff gloves, and
goggles, a respirator mask, and earphones prevented
him from hearing or seeing. Rasheed recalled that during
the flight, the detainees were hit on the head very hard
if they moved.
Upon arrival at Guantánamo American guards stripped
detainees naked while their hands and feet were in
shackles and conducted body cavity searches. Rasheed
was taken to a block where he was interrogated several

times with an interpreter. Rasheed reported that between
interrogations he was chained to the floor. He recalled
that the interrogators asked him the same questions over
and over again, and he was threatened that he would “be
forced to tell the truth.”
Rasheed recalled that these frequent and lengthy
interrogations were carried out while he was kept in an
isolation cell for five days and was deprived of his blankets. He recalled that his cell was kept very cold and that
he had blood in his urine again and suffered from nausea
and vomiting. However, he did not receive any medical
attention. Rasheed reported that he was given very little
food and was extremely hungry. He recalled that he
could not sleep because there was a constant, very loud,
unpleasant noise and “every fifteen minutes the guards
banged loudly on the doors.” Further, Rasheed noted that
the guards walked around with truncheons and dogs and
threatened to unleash the dogs on detainees. In one incident, Rasheed described that the guards tried to remove
his shirt and shorts by force. He reported that when he
resisted, two or three soldiers pushed him against the
wall, and as a result, his head started bleeding.
According to Rasheed, after he complained to the
commander and threatened to do “wild things with them,”
he was transferred to another block where the overall
conditions were better, and he was given sufficient food.
Rasheed recalled that during that time, he was interrogated by a “more friendly FBI-man” about military equipment, which he knew about from his service in his home
country’s army. Later, he was interrogated by a man from
the military. Rasheed recounted that this interrogator
tied him to the ground, threatened and shouted at him,
pressed on his throat to the point of choking, and hit him
in the chest and the jaw. Subsequently, he experienced
swelling of the jaw and pain with chewing. The interrogator accused Rasheed of being a leader of Al Qaeda
and a terrorist group in his home country and working
with the Taliban. He recalled that the interrogator also
said that Rasheed was mentally ill and threatened to
extradite him to his home country where Rasheed would
be tortured. When Rasheed refused to cooperate, he said
that interrogators used a different approach involving a
female interrogator acting in a sexual and provocative
way. Rasheed recalled that this interrogator apologized
for the rude behavior of her predecessor and came very
close to him, touched his knees and talked to him in a
seductive way. This was a very shameful experience and
very hard for him to tolerate.
To avoid further interrogations, Rasheed said that
he behaved as if he was mentally unstable. He reported

that he shouted and threw his urine at guards. According
to Rasheed, they did not punish him but his behavior
compelled the guards to call in psychologists. Rasheed
recalled that approximately every two days, two psychologists, a man and a woman, came and asked him whether
he intended to commit suicide or harm himself. There
was a big red cross on his file and on his door, which
indicated to him that he was considered “abnormal.”
Officials took away all items with which he could use
to harm himself. Rasheed recalled that he was feeling
under intense pressure, and one day he managed to find
a “device” that he could use to hang himself. He also
was able to simultaneously manipulate the lock of his
cell door, so the guards could not enter. He threatened
to hang himself unless the soldier who threatened and
harassed him was punished. According to Rasheed, it
appeared to him “they signed a contract that they would
not bother [him] any longer.”
After two months, Rasheed was transferred to block
“Delta,” which he believed was especially constructed
for detainees “who caused problems.” Rasheed recalled
that Delta block consisted of special medical blocks,
numbered 25-30, with observation cells equipped with
camera surveillance. According to Rasheed, it was
staffed by Navy personnel, consisting of one nurse, two
“psych techs” who gave out the pills, and eight other
assisting soldiers. Every two weeks a doctor with the
rank of a colonel made rounds. During his first eleven
months in block Delta, there was a female “psychological commander,” who prohibited the soldiers guarding
the block from harassing the detainees. According to
Rasheed, she was replaced by a new commander who
he believed was “educated to break us down.”
In Delta block, Rasheed stated that he was forced
to take a minimum of six unknown tablets four times a
day. The commander threatened that if Rasheed did not
take his medication, he would be given forced injections.
Rasheed stated that he was repeatedly given injections
against his wishes, which “brought [me] down to [my]
knees.” He stated that the injections would make him
“lose [his] mind” and sleep for about three days. When
he woke up, all his joints and his skin were aching as if “a
burning iron” had been forced against him. He reported
that the injections made him feel an unbearable heat
spreading through his body and caused him to get tears
in his eyes and lose his memory. Rasheed recalled that
he felt sick, asphyxiated, under enormous pressure, and
had an extreme desire to escape. He felt “so miserable

M edical E vidence of I ll - T reatment in U S D etention F acilities   6 3

that [he] didn’t want to live anymore.” 63
Rasheed stayed in Delta block for almost one year
between December 2002 and December 2003. He remembered that during confinement in Camp Delta, he tried to
commit suicide several times. He reported: “they wanted
to turn us into robots, humiliate us; they made fun of us.
The soldiers were having a good time.”
According to Rasheed, there was one “doctor” who
tried to help the detainees, and one soldier who showed
compassion. Rasheed recalled that the doctor informed
the detainees about new strategies that were planned to
break them down and warned them “that there was a spy
among them.” The detainees employed collective actions
to protest against the conditions. Rasheed recalled that
some detainees tried to hang themselves, cut their veins
with razor blades or bang their heads against the walls.
A hunger strike was organized for about ten days, and
the participants demanded to leave the block. Rasheed
reported that he did not observe any force-feeding in his
block, but in other blocks he saw detainees with feeding
tubes and intravenous drips tied to their beds. According
to Rasheed, the hunger strikers were eventually released
from Delta block under the condition that they would
stop rebelling.
Subsequently, he was transferred out of Delta block
to another block which had medium security and which
he believes served as a transition block to Camp Four,
which for many was a transition block to repatriation
out of Guantánamo. Rasheed’s medication regimen was
continued there. He had to take three to six pills four
times a day, with similar health impact, making him
mentally unstable and sleeping for approximately three
days. Rasheed mentioned that he avoided talking to the
guards. He reported that he “had no strength,” could
not eat, had “very strong saliva“, and his hands and feet
trembled. Moreover, he reported that every month he got
a forced injection. After these injections, he would feel
“like a piece of wood, completely stiff like a statue, not
like a human being.” He said he could not comprehend
what happened around him and frequently had nightmares. Rasheed reported that he tried to avoid taking all
these tablets by hiding them. However, the staff would
regularly do a blood test on him to see whether he was
taking the medication.

In addition to the above, Rasheed self-reported symptoms of strong
saliva, trembling of feet and hands, and feeling stiff like a piece of
wood after injections. These are typical symptoms of side effects
after long-term treatment with neuroleptics and antidepressants
— i.e., dyskinesia, parkinsonoid, photosensitivity.

63  

6 4   B roken L aws , B roken L ives

Rasheed described a number of occasions in which,
during cell searches, guards stamped on the Koran with
their feet. He recalled that the detainees in all five blocks
had a simultaneous uprising to oppose such practices.
The detainees banged their heads against the walls and
demanded “an end to the mocking of their religion.”
Rasheed recalled that armored vehicles arrived with
200-300 soldiers. According to Rasheed, a commanding
officer negotiated with the detainees, and after the officer
“promised that the guards guilty of offending their religion
would be punished,” the detainees stopped their protest.
During his detention in Guantánamo, Rasheed
reported that he was beaten approximately every two or
three days. He estimates that he was beaten about 300
times. Right after the first beatings in Guantánamo, he
suffered from chronic headaches. Rasheed reported that
for long periods of time in Guantánamo, he was not given
enough water. According to Rasheed the delivery of water
served in part as a means to enforce his compliance with
taking psychopharmacological drugs.
In the fall of 2006, Rasheed was released from
Guantánamo without any charges being brought against
him. Rasheed described many difficulties following his
release. He continues to live far away from his family
and community. He also reported being unemployed
and carrying the stigma of being a former Guantánamo
detainee. Rasheed stated that the transitional facility in
which he had been living at the time of the interview
—which was surrounded by barbed wire, with massive
iron barred windows and guards — constantly reminded
him of Guantánamo. He distrusts the authority figures
tasked to support him and is angry about what he
perceives as dishonesty. He noted: “I am not the person
I used to be, I have lost my kind attitude to people, I lost
my nerves. I have turned [completely].”

Summary of Guantánamo Medical File
Rasheed provided his consent for PHR evaluators to be
allowed access to his 1200-page, very detailed and extensive medical file from Guantánamo.

Summary of medical notes during the first year of
detention: Summer of 2002-Summer of 2003
Rasheed’s admission diagnosis in Guantánamo
disclosed that he had chronic watery diarrhea, right
inguinal hernia repair versus (illegible writing), dental
abscess, history of gastritis, probable irritable bowel
syndrome, and intermittent headaches.
In July 23, 2002, a first suicide attempt by hanging
is documented. Audiovisual hallucinations and selfinjurious behavior are also reported. In an evaluation

in Camp Delta, the Behavioral Health Science (BHS)
team noted personal and family history of psychiatric
disturbance as well as a history of excessive drinking
and use of marijuana. Rasheed was diagnosed with Major
Depressive Disorder (MDD) with psychotic features and
treated with sedatives, neuroleptics and antidepressants.
The medical file noted that Rasheed was held in “legal
isolation” although the file did not make clear what that
was. A couple of days later he showed severe agitation
and self-mutilation behavior (cutting himself, banging
his head against the wall), and was put in restraints
(shackled and helmeted), and his “comfort items” 64 were
taken away.
On July 27, 2002, the “psych” noted: “[W]ill rule out
personality disorder cluster ‘c’ and leave MDD as provisional for now.” On August 8, the diagnosis “psychosis
versus attention seeking behavior” is listed. On
September 18, 2002, after a suicide attempt by hanging,
Rasheed was diagnosed with Personality Disorder (PD).
The psych noted: “Pt. [patient] has a history of maladaptive coping and manipulation behavior including dramatic
and extreme behavior (e.g., self-mutilation, writing in
blood, pseudo-seizures) to deal with [detention] stress.
This self-injurious behavior is another episode characteristic of severe Personality Disorder with borderline
[and] antisocial features.”
Rasheed continuously complained of audiovisual
hallucinations with violent images of destruction, killing
and blood. On July 29, 2002, the notes stated: “[C]laims
to have been tortured by Americans in beginning of May
of 2002. He reported hearing screams and seeing people
taking children away, people with body limbs gone and
burning. States the voices said he failed his missions.
Claimed that he was reliving past experiences.”
Symptoms of severe depression as well as suicide
intentions are noted with two more suicide attempts,
one by ingesting two ice packs containing ammonium
chloride and one by hanging. The notes indicated that
Rasheed frequently requested that he be placed with a
prisoner who speaks his language and that his loneliness
[being kept in isolation] seemed to worsen his condition.
The medical notes indicate that Rasheed was in a
constant struggle with the staff, who used physical
Basic provisions in Guantánamo, referred to as “Comfort Items,”
include: one copy of the Koran, one mattress, one sheet, one blanket,
one prayer mat, one two-piece suit, one pair of flip-flop shoes,
one prayer cap, one washcloth and towel, and one salt packet for
seasoning food. The “comfort items” vary according to the location
and classification of the detainee. These items could be removed as
punishment or given as a reward for cooperation in interrogations
or good conduct.

64  

restraints and prescribed medication, including sedatives, neuroleptics, and antidepressants to control
Rasheed’s behavior. The staff wrote: “Hx [history] of
palming drugs! Be Aware!” On other occasions, blood
was forcibly drawn to check his drug levels.
For some time, bottled water was used as a privilege.
This “privilege” subsequently was taken away from him
because staff felt he was using somatic complaints as a
form of manipulation to get cold water. The medical files
noted that he gets angry when “comfort items” are taken
from him as a punishment for bad conduct, such as for
yelling and spitting on guards. Later on, his blanket was
taken away because it was reportedly used as a means
of self-harm, and this is noted as a suicide prevention
measure. The files noted that Rasheed complained that
not having a blanket was a form of torture because he was
exposed to cold temperatures at night. The files noted
that he made dolls out of paper to give himself comfort.
Rasheed’s words are quoted in the notes by the staff
and exhibit his significant despair and hopelessness: “I
want the guards stop being mean to me. I made another
doll so I could look at the woman in my dreams;” “guards
are torturing me by laughing, pointing and saying things
to me;” “I don’t know why I am cut off from the outside
world, I do not want to live any longer.” Yet another noted,
“It is this prison. This is worse than you just killed us.
You are keeping this human body alive, but killing our
souls.” On another occasion: “I am depressed and I just
want to die.” The notes also recite that he “stated that
the nightmares continue to bother me and it is driving
me crazy.”
In October 2002, he was reported as participating in
a hunger strike demanding: “Either send me home or
prosecute me.”
He constantly verbalized frustration at not having
another detainee who speaks his language with whom
he could communicate. On October 28, 2002, the psychiatric staff’s response is quoted in the file: “informed him
that psych had no control over that and told him to ask
his interrogator to have him moved.”
On November 5, 2002, he was quoted as saying: “I
want to move to the end of the cell block. There are
people down there who can speak my language and I
could take my mind off of these visions.” Three days
later, the “psych” recommended approval of his request.
The apparent rationale was that communicating with a
detainee who speaks his language would help to relieve
Rasheed’s psychotic symptoms and facilitate psychiatric care through receiving some reality feedback from
the fellow detainees. After the move, Rasheed reported

M edical E vidence of I ll - T reatment in U S D etention F acilities   6 5

that he felt better since he was able to speak to his cell
mate. The psych observed him as: “brighter affect, more
animated.”
However, on November 20, 2002, the problems escalated. The notes quote Rasheed as saying: ”I made
these dolls because they make me happy. I want to hurt
myself all the time…I see two people here and they want
to attack me. They are sitting in my cell telling me to
hurt myself.” Thereafter, his dolls were taken away,
he was placed on self-harm-prevention, and moved to
another cell. Rasheed stated that he did not want to move
away from his cellmates (who spoke his language), but
according to the medical notes, the staff moved him to
“prevent him from harming himself.” Two hours later,
he expressed suicidal thoughts. One day later, he asked
to be moved back to the cell with the detainees who
spoke his language. When his request was refused, the
file reports that Rasheed spat on the guards, was put in
shackles and taken to the shower by the guard while his
cell was searched without his presence.
A quote from the file on November 22, 2002 demonstrates the reasons the medical staff gave for Rasheed’s
self-injurious behavior: “Pt. stated he is upset because
the guards are laughing and pointing at him due to him
banging his head on the cell. Complains of sharp pain
in the back of his head and dizziness. Stated he bangs
his head because “they” won’t give him his midraine for
headaches….Discuss with pt. the reason medical did
not give midraine because his pulse was too high. Told
him that banging his head will only make it worse. Pt.
educated on consequences of banging his head and that
the guards said they’re going to put him in shackles if he
does it again.” The medical staff withheld pain-killers for
apparent medical reasons; he banged his head to protest
which in turn worsened the headaches, a vicious cycle.
This oscillation of behavior continued during Rasheed’s
entire first year of detention in Guantánamo. On April 10,
2003, he was put in restraints and isolation apparently
for spitting at another “tech.” He stated he spat as a
payback for an unjust blood drawn against his will and
because his comfort items were taken away. The psychiatrist tried to calm Rasheed down and apologize for the
blood draw. On April 20, 2003, Rasheed was observed
socializing well with his cell mate, reading a dictionary
and learning English. On May 2, 2003, he was reported as
extremely agitated, yelling and cursing at staff, threatening to spit on military police, and cutting his forearm.
Rasheed was given a cocktail injection of Ativan, Haldol
and Benadryl and was placed in restraints.

6 6   B roken L aws , B roken L ives

Two notes from May 8, 2003 described Rasheed as: “in
good spirits, no management problem”; and “detainee is
social with staff and peers. Was noted to talk and laugh.”
On July 9, 2003, the doctor on duty observed Rasheed
“as he was unresponsive and fell during interrogation
with his feet buckled but did not hit head according to
witnesses.” The medical files note that after being hydrated
intravenously and given four milligrams Ativan, he became
responsive and began talking slowly with slurred speech,
complained of severe headache and chest pain. He was
admitted to fleet hospital with a probable seizure, nonconvulsive status (seizure without observable movement
abnormalities) versus psychiatric disorder.
From July 2003 until the fall of 2006, Rasheed’s
medical records indicate that he suffered from a number
of medical problems including a possible kidney stone
and urinary tract infection, chronic diarrhea, chronic
dyspepsia, knee pain, and fractures of his fourth and fifth
fingers. He continued to suffer from chronic headaches
and had a normal CAT scan of his head. During this period
of time, the psyche notes mention fewer active psychological problems. For example, no hallucinations are
noted in the last year of detention; only “major depressive
disorder with psychotic features”; “personality disorder
NOS (Not Otherwise Specified)”, “narcissistic and antisocial features”; and “routine stressors of confinement” are
mentioned. The last psychiatrist’s progress note did not
record any active psychological symptoms or diagnoses;
it simply listed: “history of noncompliance with treatment; narcissistic Personality Disorder with borderline
features; history of hunger striking, history of suicide
attempt (3/03), history of multiple suicide gestures
including acts of self-harm by hanging or banging his
head to the wall.”

Medical Evaluation

Reported Physical Symptoms
Rasheed currently complains of lumbar pain, pain
in the renal lodges, headaches and chewing problems. He complains of loose teeth as well as problems
with his knees. He suffers from pain in the right upper
quadrant of his abdomen and has been suffering from
stomach pain for several years. In the past five years, he
suffered a few times from renal colic with blood in his
urine. Rasheed reported that his vision decreased after
release from Guantánamo. He was given contact lenses
during detention.

Assessment of Physical Evidence

Assessment of Psychological Evidence

The physical examination revealed findings consistent with Rasheed’s allegations of torture. For example,
the three-centimeter-long, linear irregular edged scar
on his forehead is consisted with Rasheed’s description
of the injury caused by being pushed against the wall
in Guantánamo. According to Rasheed, during another
beating he suffered a fracture of his hand bones. This
allegation was corroborated with information in the
medical file that noted that medical personnel splinted
and buddy taped his right small finger and fourth digit.
Further, the tenderness observed in his right hand is
consistent with fracture of hand bones allegation, but
needed to be confirmed by radiological examination.
Tenderness to palpation in the left and right lower
quadrants and the 6.5-cm-long linear scar with partial
irregularity in Rasheed’s right lower abdomen is consistent with reported surgical operation of unclear nature
during detention in Kandahar. This surgery also is
corroborated in the Guantánamo medical records which
indicate a prior inguinal hernia repair.
The examination of the musculoskeletal system
revealed findings that were consistent with his medical
records and his description of his abusive treatment,
including the observed tenderness on palpation of right
hand, general tenderness in right and left lumbar area,
the palpation to both sides in the costovertrebral angel
(renal region), and the painful movements of the right knee.
Rasheed reported that during the initial beatings in
Guantánamo, he began to suffer from chronic headaches. Rasheed stated that he was never given painkillers for his headaches or for pain in other parts of
his body. In his medical files, though, delivery of pain
killers is noted but sometimes withheld for medical
and disciplinary reasons.
Medical Tests: As might be anticipated in a subject
who has survived extensive physical and psychological
abuse and, particularly, with the complicity of medical
personnel, Rasheed was reluctant to allow a complete
medical evaluation. He was suspicious and indicated that
he believed that the medical evaluation would not help
him. The following diagnostic tests and medical consultations have not yet been completed: neurologic, urologic,
ophthalmologic and dental consultation. The evaluators
believe that an orthopedic expert opinion, including bone
scan, is needed to evaluate possible signs of non-visible,
soft tissue and bone injuries resulting from blunt trauma
during beatings. An X-ray of right hand, diagnostic
imaging studies of the head and kidneys, and laboratory
studies of blood and urine were all recommended.

Rasheed reported that he has not taken any medication since his release from Guantánamo. Following his
release from Guantánamo, Rasheed reported suffering
from frequent episodes of full body trembling. After an
episode it is “as if [his] brain stops functioning” where
he cannot type on his computer or “process information.” He suffers from flashbacks of his Guantánamo
experiences. He described numerous symptoms of
hyperarousal. For example, he continues to have difficulty sleeping. He has a disruptive sleep pattern, as he
normally sleeps about six hours a night, from midnight
to four A.M., then he wakes up and sleeps again from
five to seven A.M. He reported that he loses his temper
quickly, and he has a tendency to shout at people. Often,
when there is a misunderstanding with others, Rasheed
fantasizes he “is in a confrontation with a US soldier
standing in front of [him].” Whenever he gets the impression of dishonesty or hypocrisy, he becomes enraged. In
general, Rasheed reported that he has great difficulty
trusting people.
Rasheed was very nervous and suspicious during
and especially at the beginning of the medical evaluation. At times, the evaluators felt that they might not
be able to complete the full evaluation. Rasheed was
ill at ease, appeared to be constantly on edge and on
alert. During the days in which the medical evaluation
occurred, Rasheed was in a particularly difficult life situation as he had left the transitional facility in which he
had been living for a variety of reasons, including that it
was reminiscent of Guantánamo. Unlike any of the other
interviewees, he was homeless at the time PHR’s medical
evaluation occurred. He repeatedly expressed that he
was frustrated and felt betrayed by everybody, especially
the authorities at his place of residence. The evaluators
arranged two nights in a hotel for him during the evaluation but could not offer any long-term support or social
services, and few were available for his use. Rasheed’s
anxieties were lessened by the second day of the evaluation when he was notified of an ability to move out of
the transitional facility.
It is evident that Rasheed is deeply affected by what
he went through during his short imprisonment and
torture in his home country, and long-term confinement
and torture in US military prisons in Afghanistan and in
Guantánamo Bay. Rasheed suffered from memory intrusions, avoidance behavior and hyperarousal symptoms.
He is constantly haunted by the memories of abuses he
endured; he has sleeping problems, is extremely irritable and easily loses his temper. He is unable to concen-

M edical E vidence of I ll - T reatment in U S D etention F acilities   6 7

trate and is extremely suspicious and hypervigilant. He
reported that he has lost his basic trust in people, which
extends to people who clearly support him. He said he
believes that everyone makes false promises to him, and
he expected that PHR evaluators would do the same. He
suffered from dissociative states.65 This, as well as his
almost paranoid suspicion and his extreme irritability,
get him into trouble with people around him, including
the authorities. He described how his personality has
changed and that he felt that he is not the same person
he used to be.
His symptoms, together with the results of the psychological tests, confirm the diagnosis of PTSD with somatization disorder. Rasheed carried all three symptom
complexes — intrusion, hyperarousal and avoidance.
Rasheed’s self-endangering behavior (that occurred
while in custody), the change of his personality, his
extreme mistrust, his tendency to isolate and alienate
himself from other people and his dissociative states
are clear signs of a more severe form of PTSD - Complex
PTSD (C-PTSD). Rasheed’s symptoms of Complex PTSD
are attributed to the repeated sequential traumatization
during detention in his home country, in US custody in
Afghanistan and the four-year detention in Guantánamo.
Complex PTSD occurs in survivors of repeated on-going
trauma. The symptoms include: explosive anger,
amnesia, dissociative states, depersonalization, feelings
of helplessness, loneliness, hopelessness and despair,
social isolation, persistent thoughts of revenge, extreme
mistrust, dysfunction in interpersonal relationships, and
self-endangering behavior. 66
During the two days of the examination, the evaluators did not detect any signs of psychosis or personality
disorder, and he did not express any suicidal thoughts.
Psychological Tests:67 On the self-report measures
administered, Rasheed reported numerous symptoms of
PTSD, anxiety, somatization, and depression. Rasheed’s
responses to the Dot Counting Test, a clinician-administered test of symptom exaggeration, indicated he
From a psychological perspective, dissociation is a protective activation of altered states of consciousness in reaction to overwhelming
psychological trauma.

65  

See Judith Herman, Complex PTSD: A Syndrome in Survivors of
Prolonged and Repeated Trauma, 5 J. Traumatic Stress 377-91 (1992);
Bessel A. van der Kolk et al., Disorders of Extreme Stress: The
Empirical Foundation of a Complex Adaptation to Trauma, 18 J. Traumatic
Stress 389-99 (2005).

66  

Psychological testing included the Beck Depression Inventory, the
Harvard Trauma Questionnaire, and the Brief Symptom Inventory
and the Dot Counting Test (a clinician-administered test of symptom
exaggeration).

67  

6 8   B roken L aws , B roken L ives

responded honestly with no evidence of deliberate
exaggeration.

Analysis of Medical Records in Connection with
PHR Evaluation
Rasheed reported no previous history of diseases or
psychiatric illness and no family history of mental illness
in his PHR evaluation. However, in July 2002, a medical
evaluation by the Behavioral Health Science (BHS) team
in Guantánamo states that Rasheed told the BHS team
that he had headaches as a child which dissipated with
age. These headaches returned after he was beaten by
village people in a fight two years before his incarceration
in Guantánamo. The medical file also indicated that he
stated that he “heard and saw [imaginary] people” as a
child. Rasheed reported to the BHS team that his mother
had a similar problem. The files noted that he reported
being hospitalized for eleven days in 1991 for psychiatric
problems. The records also note that he indicated that
his condition improved with medication.
In his first medical assessment upon arrival at
Guantánamo, though, no psychiatric disorder was noted.
Rasheed stated that he was repeatedly interrogated after
his arrival. According to Rasheed, because he claimed
to be innocent and did not confess to wrongdoings, the
interrogators punished him with isolation, exposed him
to cold temperature and loud noises, shackled him in
painful positions, and deprived him of sleep. According
to his medical file, about four weeks after his arrival
in Guantánamo, and approximately half a year after his
initial detention, he attempted to commit suicide for the
first time, complained of audiovisual hallucinations and
showed self-injurious behavior. These files demonstrated
that his condition deteriorated steadily. Although the
medical file indicates he was held in isolation, he was not
removed from it. He complained of feeling lonely because
he had no one to talk to in his language. When he asked to
be moved to a cell with a cellmate who spoke his language,
the “psych” staff told him that only his interrogator could
grant him this privilege. Scientific studies name hallucinations, psychotic states and regressive behavior as
frequent and typical effects of isolation.68 According to
the medical file, Rasheed had audiovisual hallucinations
and showed regressive behavior, i.e., making paper dolls
and talking to them. This mental anguish is consistent
See Peter Kempe & Jan Gross, Deprivationsforschung und Psychiatrie,
Sonderdruck aus Psychiatrie der Gegenwart, Bd 1 u. 2. 2. Aufl., (1980); P.
Kempe et al., Sensorische Deprivation als Methode in der Psychiatrie,
45 Nervenarzt 561-68 (1974); Craig Haney, Mental Health Issues in LongTerm Solitary and “Supermax” Confinement, 49 Crime & Delinquency
124-56 (Jan. 2003).

68 ��

with reports of agitation and self-injurious behavior in
Rasheed’s medical file and his self-report.
As noted above, in evaluations of Rasheed after his
suicide attempt, the BHS team at Guantánamo noted a
history of psychiatric disorder, which Rasheed denied
in the evaluation interview, possibly because he felt
ashamed disclosing it. The details of that history are
vague and the BHS team did not report any specific
psychiatric diagnosis. He certainly was, and is, a very
vulnerable person. It may be inferred that under the
condition of extreme stress and maltreatment in detention a latent pre-existing psychiatric disorder recurred
and exacerbated in terms of a major depression with
several suicide attempts and psychosis. The BHS team
attributed his aggressive outbursts, mood swings and
self-injurious behavior as signs of borderline personality
disorder. During his medical evaluation with PHR evaluators, and in his self-report, Rasheed said that he behaved
like “a mental case” to avoid further interrogations. In
fact, one can infer from his Guantánamo medical file that
his abnormal behavior was at least partly intentional.
Therefore his borderline behavior, and his reported selfhistory inside Guantánamo, may have been deliberate
shamming to protect himself from ill-treatment and
duress in Guantánamo. On the other hand, his abnormal
behavior escalated whenever the guards punished or
mistreated him. From the medical file one can conclude
that he also behaved that way as a form of protest to his
detention conditions.
In the medical files, Rasheed continuously complained
of audiovisual hallucinations with violent images of
destruction, killing and blood and told his caretakers
that he “was reliving past experiences” and had “been
tortured by Americans” while detained in Afghanistan. It
is likely that, in fact, these hallucinations, in part, reflect
his real experiences. According to the traumatic history
Rasheed gave the PHR medical evaluators, he described
in detail his beatings and torture after he was handed
over by Northern Alliance troops to US forces and kept
in several military prisons in Afghanistan.
After he was diagnosed by the BHS team as being
mentally ill with a pre-detention history of psychiatric
disorder, one would reasonably expect that Rasheed
would be classified as a person with severe mental health
problems and be taken off the ordinary prison regime.
In particular, concern for his health would have led to
removing him from isolation, which, at the very least,
appears to have exacerbated his mental health problems.
Instead, however, interrogators reportedly continued to
subject him to solitary confinement, removed basic items

such as his blanket and separated him from the other
detainees who spoke his language. From the medical
records, it appears that the psychologists, doctors, and
nurses made some attempt to address Rasheed’s severe
psychological symptoms. However, they did not evaluate
Rasheed’s symptoms of PTSD, which Rasheed manifested early in his incarceration. Also his medical records
do not indicate that he received supportive and verbal
therapies. Instead, against his will, Rasheed was treated
exclusively with psychopharmacological drugs, which
were associated with severe side-effects. Moreover, the
records do not indicate that the health professionals
inquired into or documented any form of ill-treatment
that Rasheed was enduring, much less the relationship
between that ill-treatment and his mental condition.
Under the circumstances, the psychiatrist’s and psych
tech’s mention of “routine stressors of confinement” in
their list of diagnoses seems to be a deliberate attempt
to minimize the nature and extent of Rasheed’s psychological symptoms and to disregard cruel, inhuman and
degrading treatment as a likely cause of these symptoms. It is possible, moreover, that the mental health
interventions may even have worsened the suffering of
Rasheed, by patching him up sufficiently so that further
interrogation and torture could be inflicted. These all
suggest that the health professionals either willingly or
unwittingly aided the ill-treatment.
There is further supporting evidence that ill-treatment
was the cause of Rasheed’s psychological symptoms.
His psychotic and depressive symptoms lessened after
he was transferred to blocks with less harsh conditions,
including being transferred to Camp Four in August 2005,
and subsided completely before his release. On July 7,
2005, the psychiatrist noted that Rasheed would be
removed from the Behavioral Health Services Program
because his Psychotic Disorder NOS (not otherwise
specified) was considered stable. To the diagnosis Major
Depressive Disorder, the words “Single Episode, Mild to
Moderate” were added. In the last year of detention the
diagnosis psychosis NOS was dropped, as well as the
diagnosis of Major Depression in the last medical evaluation in October 2006. The only remaining psychiatric diagnosis, then, was narcissistic personality disorder with
borderline features. The PHR evaluators believe that it
is reasonable to infer that with the prospect of his imminent release, his symptoms of psychosis and depression
resolved. At the same time, the PHR evaluators consider
the diagnosis of personality disorder cluster B as questionable. Judgment of personality is very much shaped
by cultural concepts and values. It is evident from the

M edical E vidence of I ll - T reatment in U S D etention F acilities   6 9

medical files that many of the problems between Rasheed
and the Guantánamo staff, including the medical staff,
may be attributed to ill-treatment, extremely stressful
conditions of detention and intercultural communication
problems. As stated above, Rasheed may have intentionally behaved like a borderline-case to protest against
ill-treatment and avoid interrogations.
Rasheed told PHR evaluators that after being handed
over to US forces and Northern Alliance troops in
Afghanistan and held in Mazar-i-Sharif, and Bagram
and Kandahar prisons, he was severely and repeatedly
beaten on all parts of his body (e.g., kicked in his belly
and head), that he lost consciousness and suffered from
a severe abdominal trauma. In the military hospital in
Bagram, he was told that he had to have an emergency
operation on his kidney. Rasheed reported that when he
woke up he was told it was “not an appendix”. Rasheed
may have suffered from a strangulated inguinal or
femoral hernia, an abnormal displacement of a loop of
bowel through the abdominal wall and in association with
compromised blood flow to the affected bowel segment.
It is also possible that he was operated on for a traumarelated injury such as a hematoma (collection of blood)
or a contusion or rupture of an abdominal organ.
Rasheed had a pre-detention history of headaches. His
chronic, severe headaches in detention are likely due to
stress-related psychological symptoms, but also may be
related to post-concussion effects of head trauma from
beating that occurred in his home country, Bagram and
Kandahar and his frequently noted self-harm behavior
of banging his head against the wall in Guantánamo.
He also reported one incident where his head started
bleeding after Guantánamo guards pushed his head
against the wall. The CT of the brain obtained on June 7,
2004 in Guantánamo did not demonstrate any significant
abnormality, but this does not exclude the possibility of
a post-concussion syndrome.

Analysis and Conclusions
The historical, physical, and psychological evidence
strongly supports Rasheed’s allegations of torture and
cruel, inhuman and degrading treatment.
Rasheed’s present mental and physical condition is
fragile. He suffers from a wide range of physical complaints
due to injuries endured during detention. Rasheed’s
general mistrust in people made it very difficult to establish trust in the course of the medical and psychological
evaluation. Some of his testing remains incomplete.
The medical history and physical examination support
Rasheed’s report of multiple injuries, and are consistent
7 0   B roken L aws , B roken L ives

with the abuses he described. For example, the linear
scar on his forehead is consistent with allegations of
his head being pushed against the wall by soldiers in
Guantánamo. The medical examination also supports
Rasheed’s history of having gone through an acute
abdominal operation of an unclear nature in Kandahar.
The fracture of two fingers of the right hand is consistent
with the allegations of abuse but need to be confirmed
by radiological examination.
Additionally, Rasheed described a history of chronic
headaches that are most likely due to stress during
detention and post-concussion syndrome after multiple
episodes of head trauma from beatings during detention in his homeland, US military prisons in Bagram and
Kandahar and self-harm behavior in Guantánamo.
Based on the self-report, the psychological tests, the
evaluation of the Guantánamo medical file and clinical
findings, Rasheed suffers from complex post-traumatic
stress disorder with somatization disorder due to severe
sequential traumatization by physical and psychological
torture for a lesser period in a prison in his home country
and over a long period of time in US military prisons
in Afghanistan and Guantánamo. Rasheed described
numerous symptoms indicative of PTSD, including intrusive thoughts and memories of the traumatic events (e.g.,
feeling haunted by the memories of his abuse), avoidance and emotional numbing behaviors (e.g., lost of basic
trust in people, being extremely suspicious, dissociative states), and hyperarousal symptoms (e.g., sleep and
concentration difficulties, anger and loss of control), and
he shows self-endangering behavior. He further reported
a change of his personality that has limited his ability
to function, as he would like to, in daily life and interact
with other people.
During detention in Guantánamo, Rasheed suffered
from a three-year episode of major depression with
several suicide attempts, psychosis and self-injurious
behaviour. These conditions should be considered in
connection with a likely pre-detention history of psychiatric disorder that recurred and exacerbated due to physical and psychological torture in US military prisons in
Afghanistan and Guantánamo.
There are some contradictions and missing links in his
self-reported history. On the one hand, Rasheed has an
impressive memory; he remembers details, names, and
dates that match with the data from his medical file. On
the other hand, parts of his memory are fragmented. This
combination of hypermnesia and hypomnesia is a typical
post-traumatic symptom in survivors of severe trauma.
We have no reason to doubt the credibility of Rasheed’s

allegations. Moreover, Rasheed’s allegations of trauma
are congruent and consistent with the information in his
medical records. Also the clinician-administered test of
symptom exaggeration indicated that Rasheed responded
honestly with no evidence of deliberate exaggeration.
The question arises as to why an obviously sick and
vulnerable person with a possible history of psychiatric
disorder was kept in detention for four years and exposed
to the full range of stressors of confinement, some of
which amount to torture, in Guantánamo including long
interrogations, physical abuse, verbal threats, prolonged
isolation, exposure to cold temperature and loud noises,
violation of religious and moral codes, and sexual humiliation. These stressors seriously exacerbated and/or
caused the psychological symptoms observed in the
medical files during detention, some of which have
persisted to the present time. The Guantánamo medical
file show that doctors and nurses provided Rasheed a
high level of access to care. Although the motives of
the medical personnel cannot be gleaned from a review
of Rasheed’s medical record, it is clear that these
individuals, particularly the mental health personnel,

contributed to Rasheed’s stress-related psychological
symptoms by not adequately identifying the cause of his
psychological symptoms, failing to obtain his consent for
medical interventions, and failing to seek an end to physically and psychologically destructive practices carried
out by US interrogators and guards.
It appears that the clinicians involved in Rasheed’s
care were negligent in their duty to inquire about and
document possible evidence of torture and ill-treatment.
In addition, they failed to recognize and address the
causes of Rasheed’s profound psychological symptoms
of complex PTSD.
Rasheed’s current mental and physical condition
is negatively impacted by the fact that he has been
uprooted, lives in poverty, and is socially isolated by
being cut off from his family. Rasheed described his
life since his release as an extension of his detention in
Guantánamo. He has little opportunity for building a new
life or finding a job. Further, no adequate health care
and psychological support is available to him. Rasheed
is in urgent need of social, psychological, and medical
assistance and support.

M edical E vidence of I ll - T reatment in U S D etention F acilities   7 1

7 2   B roken L aws , B roken L ives

IV. Patterns of Torture and
Ill-Treatment

[In Abu Ghraib] the torture stopped, but they started
trying to affect me psychologically — I was in a very
dark and small room [measuring approximately 1.5 by
2 meters] and I was totally [naked]. And the weather
was very, very cold — and you don’t have any blanket
or clothes to wear and I was sitting on the ground. And
you don’t know what is there on the ground and you
don’t know where you [are], and there was very scary
silence. The only thing you can hear is the voices of
those who [are being] tortured at that time — screams
and cries.
An Iraqi former detainee
evaluated by PHR

T

his chapter synthesizes the evidence of ill-treatment detailed in the eleven individual accounts in
the previous chapter according to common themes
of abuse. It reports no facts that are not contained in
the case narratives, but instead shows how the torture
and ill-treatment experienced by the interviewees were
not random and isolated occurrences, but instead were
part of a larger pattern of abuse. In seeking to differentiate among various techniques of torture there is some
repetition in this chapter because the US personnel
employed multiple forms of torture on these men at the
same time.
The experiences of the eleven detainees evaluated
for this report varied considerably, not only among the
three theatres in which they were held (e.g., Afghanistan,
Iraq, and Guantánamo Bay, Cuba), but in some cases,
among those held in the same facility. Nevertheless, all
except one of the Iraqi former detainees were severely
and relentlessly brutalized during at least part of their
detention. The former Guantánamo detainees experienced severe physical abuse during both their incarceration at facilities in Afghanistan before being transferred
as well as during their initial detention at Guantánamo
Bay. Moreover, all the men evaluated experienced interrogation and detention conditions that involved one or
more of a number of draconian and unlawful practices
including isolation, sleep deprivation, sensory depriva-

tion, stress positions, and sexual humiliation that were
conducted in an official capacity and were specifically
authorized at each facility during the time that these men
were under US custody.69
It is also noteworthy that none of the individuals evaluated was given any official explanation for his arrest and
detention or charged with a crime, let alone convicted.
None has received either an apology or compensation
from the United States for the grievous ill-treatment they
experienced.

Beatings and Other Ill-Treatment
During Arrest, Transport, and Initial
Custody
The arrests of the Iraqi former detainees were characterized by American personnel inflicting a very high level
of violence against them. Six of the former detainees
reported being arrested late at night or early in the
morning, and five stated that they were arrested at their
places of residence. Four reported being beaten during
their arrest, some in front of their families. One man
recounted that during his arrest US personnel threatened
to shoot him if he moved. Another detainee, who suffers
from diabetes, reported that when he was arrested he
was not given an opportunity to take his medications with
him, and that he was not provided with food until the
second day of his detention. Another Iraqi former detainee
recalled being handcuffed, kicked and beaten with guns
until, as he described, “I was swimming in blood.”
The former detainees were not the only subjects of
physical abuse at the time of their arrests. Two of the
Iraqi former detainees evaluated reported that American
soldiers abused their family members as well. One
recalled that he and his family were forced to both lie
down and walk on the broken glass created when the
See PHR Break Them Down, supra note 17; Office of the Inspector Gen.,
U.S. Dep’t of Defense, Review of DoD-Directed Investigations of Detainee
Abuse (U), Rep. No. 06-INTEL-10 (2006), available at http://www.fas.
org/irp/agency/dod/abuse.pdf; Schmidt Report, supra note 6; Fay
Report, supra note 18.

69  

  73

soldiers “bombed” the windows of his house. This individual recalled that the glass shards remained embedded
in his feet for many months, including throughout his
incarceration at Abu Ghraib. He reported that his wife
and children were also blindfolded and beaten. He
told PHR that he believed the beating caused his wife,
who was four months pregnant, to have a miscarriage.
According to another Iraqi former detainee, at the time
of his arrest, “One of the soldiers hit [my wife] on the
head with his gun.” He reported that his wife currently
suffers severe damage to her vision, he believes, as a result
of this assault.
Of the four Iraqi former detainees who were arrested
in their homes, three reported extensive damage to their
personal property during their arrest. One recalled that
his home and car were destroyed by American explosives.
Another man had a similar experience, recalling that
his home “was bombed,” his door, walls, and windows
demolished. He also stated that the soldiers who arrested
him had stolen property from his domicile and destroyed
the remaining items.
After being taken into custody, six of the former
detainees reported violence inflicted on them by American
forces during transfer to their various holding facilities
and shortly after their arrival. Indeed, many of the most
severe injuries from beatings documented in this report
occurred during the former detainees’ arrest, transfer
and initial custody.
The beatings inflicted on detainees upon their arrival
at US facilities in Afghanistan before they were transferred to Guantánamo were particularly intense. Two
interviewees reported being beaten by US soldiers
during their transfer to Bagram or an unknown prison in
Afghanistan. Another former detainee recalled that while
being transferred from Peshawar to Bagram, he and fifty
other detainees on the plane were hooded, chained to the
floor of the plane, and shackled very tightly around their
chests and waists such that breathing was difficult. He
stated that during the fifteen-hour flight, detainees were
beaten and insulted if they moved. Further, he recounted
that one American soldier grabbed him by the throat
and threatened to choke him. Another individual, who
was in poor health, recalled that during his transfer from
Bagram to Kandahar he was hooded; his hands and feet
were tightly shackled; his knees were held together in a
kneeling position with adhesive tape; and he was tied to
the floor so that he was unable to move.
Upon entry at a detention facility in Kandahar run by
American soldiers, one individual stated that he was
forcefully kicked while on the ground, causing his lip to
7 4   B roken L aws , B roken L ives

swell. He also reported that his head was hit against
wooden columns and he was beaten so mercilessly that
three of his teeth fell out and a fourth was later removed
at Guantánamo. A similar experience was reported
by another individual; upon his arrival at a Kandahar
detention facility, this individual recalled being beaten
with sticks and fists, while being kicked repeatedly in
his genitals. Upon arrival at a US-operated facility at
Bagram airport, another former detainee recalled that
he was tied very tightly to a rope with other detainees,
causing him severe pain as they were dragged into a hall.
Further, he reported that the detainees were beaten if
they refused to remove all of their clothes. This same
former detainee also recalled that, at Bagram airport, he
was beaten almost every day as a punishment for talking
to other detainees.
The four former detainees who were transported to
Guantánamo Bay, Cuba reported very harsh treatment
throughout the transfer process. As in Iraq, the most
intense and widespread physical brutality took place
during transfer and shortly after arrival. This physical
abuse was accompanied by extreme stress positions and
humiliation. At least one of the men evaluated recalled
that when he was transferred, he was forced to disrobe in
front of female soldiers, was clothed in an orange suit, and
had his ears covered with headphones and eyes covered
with dark goggles. All four Guantánamo detainees stated
that they were handcuffed and chained in a crouched
position to a hook on the floor for the duration of the
transatlantic flight. Two former detainees recalled having
been forced to wear a respiratory mask, black goggles,
earphones with a humming sound, and long firm “special
gloves so that you cannot move your fingers.”
According to one individual, the guards forced the
detainees to take a drug that made him hallucinate.
According to another man, upon arrival at Guantánamo
the detainees were hooded and beaten by the soldiers
while they were taken to their cells. Soldiers kicked them
and threatened them with dogs. This individual recalled
that he was punched and dragged, causing bleeding and
bruises “all over” his body. Another reported enduring
significant pain during transport from one camp in
Guantánamo to another, when he was hooded, his hands
and feet were chained, and his body was pushed forward
in a painful position.
Two of the former detainees from Guantánamo
also reported that even during their return flight from
Guantánamo to their home countries, they were handcuffed, blindfolded, and chained to the floor of the
airplane throughout the lengthy flight. One former

detainee also stated that upon his release and transfer
from Guantánamo, his personal items were not returned
to him.
Physical evidence of beating often was not detectable because the medical evaluations were conducted
after the resolution of the acute signs and symptoms.
However, the findings from bone scans of six individuals corroborate the history of beatings described by
the former detainees. For example, one former detainee’s bone scan revealed increased focal activity of both
shoulders consistent with degenerative arthritis. The
presence of this condition corroborates his allegation
that he was forced to maintain uncomfortable arm positions for extended periods of time during his transfer to
Guantánamo. Moreover the scars and lesions observed
on all the former detainees were consistent with their
reports of injuries sustained during their arrest and
detention. For example, the lesions noted on the heads
and noses of two individuals could corroborate the blunt
trauma they described earlier.

Deprivation of Basic Necessities and
Sanitary Conditions
The poor conditions of confinement in US detention facilities described by former detainees, especially in Iraq but
also in Afghanistan and during the first year Guantánamo
Bay was in operation, constituted a substantial form of
ill-treatment by themselves. All of the former detainees
evaluated by PHR reported experiencing lack of proper
sanitation, hygiene, food, and clothing. Further, uncertainty regarding their fate (i.e., whether charges would
be brought against them, whether they would be killed,
whether/when they would be released) and the denial
of, or substantial delay in, communication with family
significantly affected these individuals.
Detainees destined for Guantánamo were deprived of
food and sanitation during the initial stages of their detention. One former detainee reported that while detained
in Bagram airport, detainees were fed cold meals and
inedible moldy bread. He also stated that while in detention in Bagram airport, “It was not easy to go to toilet”
because the toilet was a non-closable public toilet shared
among all of the detainees. He reported that he and many
other detainees often did not eat in order to avoid having
to use the toilet. He also recalled that the detainees were
only allowed to take communal showers and were only
given one to two liters of water for bathing. This former
detainee also recalled not being given a toothbrush and
toothpaste and having resorted to using a piece of plastic

to clean his teeth; in fact, he reported that when he was
caught trying to save a small plastic bag to use for the
same purpose, he and his fellow detainees were beaten
as a group punishment. He also stated that detainees
had to eat while being handcuffed.
Detainees who arrived at Guantánamo Bay’s Camp
X-Ray in early 2002 experienced brutal conditions. One
explained that they were kept in “steel cages and it was
really, really hot, even in the night.” This individual also
stated that the detainees were let out of the two metersquare “cages” only for questioning, were not allowed
to speak to each other, and had to use a bucket as a
toilet. Similarly, another former Guantánamo detainee
described conditions at Camp X-Ray as “egregious —
the conditions we were living in — we were treated like
animals…they were treating the dogs better than they were
treating us.” One detainee also recalled that his daily food
rations in Camp X-Ray of Guantánamo were meager.
A few weeks after arrival at Guantánamo, two former
detainees evaluated by PHR reported having been transferred to Camp Delta, and they described overall detention conditions as improved. These individuals stated that
Camp Delta had been built recently and included toilets
and running water in the cells. However, the detainees
were still confined to their two-meter square cells and
let outside only for about fifteen minutes once a week
to exercise, although this later increased to two or even
three times per week. Other than these brief exercise
periods, one detainee recalled that he was only allowed
out of his cell for interrogations or “to go to the bathroom” and clean himself.
Moreover, movement into the other camps did not
always mean an improvement in conditions, especially for those kept in isolation. One former detainee
stated that for five days he was kept in an isolation cell
in Guantánamo, where he was given very little food,
was extremely hungry, and was deprived of his blankets. Another detainee recalled that in Guantánamo the
soldiers would sometimes spit in or throw out part of
their food rations. Another former detainee recalled
that in Camp I of Guantánamo during Ramadan, while
he and the other detainees were fasting, they received
reduced quantities of food at ordinary meal times instead
of the religiously appropriate time (e.g., before sunrise
and after sunset). He also recalled that he and the other
detainees would receive one piece of meat the size of a
matchbox. Similarly, another former detainee recalled
that for long periods of time in Guantánamo, he was not
given a sufficient quantity of water. One participant attributed getting fungus on his feet and his axillary (armpit)
P atterns of T orture and I ll - T reatment   7 5

area to the fact that in Guantánamo the detainees did
not have personal overalls and their clothes would get
mixed up at the laundry.
The physical circumstances at American facilities in
Iraq were, if anything, worse. One Iraqi former detainee
stated that during his initial days of detention at an
American-controlled camp, the bathroom was an open
space “and we were constantly watched by soldiers when
we did our business.” Another Iraqi former detainee
stated that unsanitary conditions at Abu Ghraib worsened an infection that he had developed in his toe. In
the Abu Ghraib communal tents where one individual
was detained, he reported that the unsanitary conditions there seemed to be a form of group punishment.
He reported that the detainees were occasionally denied
access to a toilet. “Some of the prisoners were peeing in
their clothes,” he said. Another individual stated that he
was intermittently placed in “lockdown,” where he and
the other prisoners would be kept for durations of up to
twenty-four hours without food, water, or access to a
toilet. Yet another reported being placed in the “punishment room” in Abu Ghraib several times, where he developed rashes and allergies due to the deplorable sanitary
conditions, such as the presence of urine on the floor
of the room. One Iraqi former detainee recalled that he
was forced to wear the same filthy suit for seven months.
Another Iraqi former detainee recounted being forced to
wear soiled underwear, often for weeks or months at a
time. He told PHR: “I had diarrhea and I was in handcuffs.
I was making my toilet in my underwear and I was very
dirty. That was very painful.”
Moreover, an Iraqi man recalled that in Abu Ghraib,
the food that he was given was “barely enough” and was
“really bad.” He reported that his food would be thrown
or kicked by the guards into his cell in a small bag and
was sometimes thrown into or near the toilet.
In addition to the denial of food and a lack of access
to a toilet, eight of the former detainees were denied
clothing or were kept naked during portions of their
detention.70

Stress Positions: Forced-Standing,
Handcuffing, and Shackling
[O]ne time they took me to be questioned and there was
a chain coming from the ceiling. It was a winch. They
pulled me [by my wrists, from behind] and they left
Forced nudity and denial of the most basic forms of decency
and privacy will be discussed in detail in the Sexual Humiliation
section.

70  

7 6   B roken L aws , B roken L ives

me for about four hours. Only my toes were touching.
I started saying to them ‘it is very painful — I have a
very severe headache’ and after that I passed out.
An Iraqi former detainee
evaluated by PHR
Except possibly for the use of isolation, the most
frequently employed form of torture reported to PHR
was the use of stress positions. All former detainees
reported having been subjected to painful stress positions, often for long periods of time, including during
lengthy interrogations.
Individuals detained in Afghanistan before being sent
to Guantánamo were subjected to the routine use of
stress positions. One former detainee stated that upon
his arrival in Kandahar, he was stripped naked, forced
to wear goggles and earphones, his hands and feet were
shackled, and he was tied to a table with his hands behind
his back. This same man recounted another episode
where he was beaten so severely during an interrogation
at Bagram that he lost consciousness; he was subsequently hospitalized while handcuffed and strapped to
the bed with a leather strap. Another former detainee
recalled one incident in Bagram where he was beaten
by guards who believed he was speaking to another
detainee while reciting the Koran during prayer. He was
beaten and chained to barbed wire for several hours,
and he recalled that it was excruciating to be suspended
that way because the barbed wire hurt him when he lost
his balance.
Detainees described interrogations at Guantánamo
as often accompanied by shackling and stress positions.
One former detainee recalled that between interrogations at Guantánamo he was chained to the floor. Two
others reported that they were held in extremely hot or
cold interrogation rooms chained to a ring on the ground
for extended periods of time (“forcing us to sit chained
for eighteen or twenty hours”). They both described this
experience as extremely painful.
An Iraqi former detainee described being suspended
in painful positions on numerous occasions, often being
elevated off the ground for hours at a time — resulting
in a dislocated shoulder and pain that plagues him to
this day. Three Iraqi former detainees reported losing
consciousness as a result of being subjected to painful
stress positions. One described being suspended in his
“cage” in Abu Ghraib and forced to spend many hours
with one arm elevated and another tied to his ankle, or
being chained to a bed with his arms and legs splayed
apart. In another episode he was lifted off the ground by
his arms which were tied behind his back, and he felt

his shoulders being dislocated. This individual estimated
that the “free suspension” (elevation above the ground
by his arms) occurred “not less than four or five times”
and added that he was chained to the window every day,
especially at nights in order to deprive him of sleep. He
added that dogs were brought to frighten him while he
was suspended, and they scratched his hands and arms.
Another detainee recalled being suspended in a similar
manner while detained at Baghdad airport with “some
kind of a machine—a winch.” He reported having lost
consciousness twice and that the interrogators threw
cold water at him to revive him so they could continue
his interrogation.
Another Iraqi former detainee described being handcuffed to the ground during an interrogation in Abu Ghraib.
This individual reported being forced to assume painful
postures for extended periods of time. He demonstrated
one position in which one hand was tied to the floor and
a second raised above his head. He reported having to
maintain this position for approximately a full day, after
which time the soldiers put him in another stress position. Another Iraqi individual described that while at Abu
Ghraib, after being kicked in the shoulders and legs, he
was forced to stand on an injured foot with one hand
tied to the upper bunk of his cell. Another Iraqi former
detainee reported that in the first days of his arrest at
an unknown detention location, while he was blindfolded
and his hands were shackled behind his back, he was
forced to stand for five to six hours together with other
detainees. He noted, “We were in a miserable [state].”
The severity of the detainees’ physical restraints was
often exacerbated by the accompanying blindfolding,
hand-cuffing, shackling, sleep deprivation, isolation, and
exposure to temperature extremes that often occurred
during detention as well as during interrogation. One
individual recalled that, while in detention in an unknown
location in Iraq, he was blindfolded, handcuffed behind
his back, and then forced to bend over and walk in a
zigzag while soldiers pushed him into the wall. Another
Iraqi former detainee described that during his first interrogation in an unknown place in Baghdad he was hooded
and chained while suffering significant pain because of
broken glass embedded in his feet. Another Iraqi former
detainee reported that while he was detained along with
other prisoners in an American-controlled “camp,” he
was kept hooded and handcuffed with his hands behind
his back in a large hall for several days. One individual
recalled being forced repeatedly to lie with his hands and
feet tied together behind his back, in what is conventionally known as a “hog tie,” for up to an hour at a time. One

of the Iraqi former detainees described an incident in Abu
Ghraib when he was thrown into a muddy pool of water
with his hands and legs shackled. Another individual who
was detained in Iraq reported that while in Abu Ghraib,
he was forced to stand in his cell the entire night, naked
and handcuffed to his bed, as he was doused with water.
The same individual recalled another episode where he
was tied to the bars of his cell and forced to stand in that
position the entire night. Another detainee in Abu Ghraib
recalled having been kept in a cold, dark room for the first
three weeks of his incarceration, shackled throughout
much of this time.
Medical evaluation, while not conclusively confirming
these accounts, was consistent with them. All of the
former detainees reported that they continue to suffer
from diffuse musculoskeletal pain, and pain in limbs,
joints, muscles, and ligaments that they did not experience prior to detention. For example, one detainee
reported arm numbness and weakness following being
suspended by his arms (“free suspension”), which is
highly consistent with a brachial plexus injury that
often results from this type of suspension. Since his
release from Abu Ghraib prison, this individual has
been suffering from chronic pain in his neck, legs, right
shoulder, and feet, all of which he attributed to injuries
sustained during his incarceration (from beatings and
being suspended in stress positions). Another former
detainee described experiencing daily lower back pain
and numbness in his legs, which began while he was in
Guantánamo, and is exacerbated by lifting heavy objects
and walking. This type of injury corroborates the allegation of being subjected to shackling and handcuffing for
extended periods of time. Additionally, the thinning of the
skin and decreased hair on this individual and another
former detainee’s wrists were attributable to handcuffs
having rubbed against their skin.

Isolation, Sensory Deprivation, or
Bombardment
The use of isolation, sensory deprivation, and sensory
overload became almost routine in the treatment of
detainees, especially during — but not restricted to —
the first few months of detention.

Prolonged Isolation
All of the men evaluated by PHR reported being subjected
to lengthy periods of isolation, one for as long as two
months at a time and others for periods ranging from
about ten days to more than a month. Most also reported
being kept in small, dark holding cells that one Iraqi
P atterns of T orture and I ll - T reatment   7 7

former detainee said made him feel “claustrophobic.”
The men reported that while being kept in isolation they
were subjected to multiple other forms of ill-treatment
including shackling, blindfolding, physical abuse, humiliation, sexual humiliation, and stress positions as well as
temperature and light control.
One former detainee reported that after a lengthy
interrogation in Guantánamo, for about one month, he
was kept in a small isolation room that was constantly
air-conditioned and was very cold. He described the isolation cell as a metal container with a bed and a toilet. At
another time, he was punished with two weeks of isolation because he refused to speak to an interrogator. In
another incident, he recalled being put in extreme isolation for a period of two weeks in Guantánamo before
being interrogated. This individual stated that during this
extreme isolation period, detainees were bombarded with
loud music and given many different kinds of medications and numerous injections. As noted above, another
detainee recalled that while repeatedly being subjected
to lengthy interrogations, he was put in isolation for five
days in Guantánamo; deprived of his blanket, sufficient
food, and sleep; and was denied medical attention for his
nausea, vomiting, and blood in his urine.
In another case, a detainee developed severe mental
health problems that could be directly attributed to his
isolation, including suicide attempts, banging his head
against walls and other objects, and hallucinations.
Nevertheless, he was treated with heavy doses of psychotropic drugs and continued to be kept in isolation for
considerable periods of time. Only months after these
symptoms appeared did the medical staff seek to have
him removed from isolation.
According to the detainees’ accounts, isolation in
Iraqi facilities was an even more routine procedure. As
described above, one Iraqi former detainee reported
having been taken to a dark room where he was shackled
for most of the time and kept isolated and naked in a cold
cell for approximately the first three weeks of his incarceration there. Another Iraqi former detainee similarly
recounted that he was kept in isolation at an unknown
prison for a period of twenty-seven days during which
time he was frequently interrogated.
One Iraqi former detainee recalled that he was detained
in the Baghdad airport prison inside a dark room dressed
only in his underwear, with a hood covering his head. His
hands and feet were tied, and he was periodically beaten
and kicked. This individual was subsequently subjected
to similar treatment at Abu Ghraib. He stated that he was
held for approximately thirty-five to forty days in isolation
7 8   B roken L aws , B roken L ives

in a dark cell measuring approximately 1.5 by 2.5 meters.
He described the room as “a cage, and inside this cage
there [was] another cage.” He reported that at times he
was forced to stay inside the smaller cage. During this
time, he reportedly underwent lengthy, intense interrogation sessions lasting up to nine hours at a time.
Another Iraqi former detainee stated that he was kept
in an isolation cell for about fifty days—the first fifteen
days of which he was kept naked and without a blanket.
Upon his arrival at Abu Ghraib prison, yet another man
recalled that for approximately two months, he was kept
naked in a dark, windowless, cold room that smelled like
urine. During this time, he reported the recurrent practice of being forced to stand naked and hooded outside
of his cell for several hours at a time.
One former detainee recalled the conditions of isolation while detained at a facility at Saddam Hussein’s
former ranch, “Being in solitary was the worst…There
was nothing in the cell. I was watched when I went to
the bathroom, with the gun pointed at me.” Another Iraqi
former detainee reported being isolated, completely
naked and alone, in a small, totally dark cell for over
three weeks upon arriving in Abu Ghraib.

Hooding/Blindfolding
Sensory deprivation by means of hooding or other
types of blindfolding was reported by all of the former
detainees evaluated in this investigation. Apart from
being subjected to these techniques during arrest and
transportation between facilities as described earlier,
detainees, particularly those held at Abu Ghraib, reported
being blindfolded during interrogations and during
general detention. Blindfolding was generally done by
placing a hood or plastic bag over the head or a plastic
mask over the face. Blindfolding was frequently used in
combination with other techniques, and the detainees
reported that it instilled in them feelings of fear, disorientation, and dependency.
Detainees held in Afghanistan before being transferred to Guantánamo reported that hooding was used
in combination with other abusive tactics. One former
detainee recalled that in one interrogation session at
Bagram while he was hooded he was subjected to severe
beatings to the point that he lost consciousness. As noted
previously, this individual recalled that he was put in a
stress position upon arrival at Kandahar while he was
wearing goggles and earphones that prevented him from
hearing and seeing. At Guantánamo, on the other hand,
the four detainees evaluated experienced hooding only
when being moved.

In Iraq, hooding was a more routine practice. One
former detainee recalled being hooded during his first
interrogation upon arrival at Abu Ghraib prison. Another
former detainee in Abu Ghraib reported having a bag put
over his head while a soldier lit a cigar and blew smoke
into the bag. A third explained how he was hooded while
being physically assaulted: “They were kicking me in my
chest, my abdomen … I had a bag on my head, so sometimes they made me walk into the wall, because I could
not see anything.”
Another Iraqi former detainee recalled a recurrent
practice in Abu Ghraib, described previously, of being
forced to stand naked and hooded outside of his cell for
hours at a time. In an unknown prison, another Iraqi
former detainee described being hooded for approximately three consecutive days following his initial
arrest. During that period he suffered other abuses,
including being forced to maintain uncomfortable stress
positions.

Sensory Bombardment
For two months I couldn’t sleep because there was
very strong light. We didn’t know if it was day or night.
If you fell asleep just for a few minutes they played very
loud American music, so you could not sleep.
Former Bagram detainee
evaluated by PHR
According to eight former detainees evaluated by PHR,
sensory bombardment with loud noise or music or
extreme light was utilized in what appeared to them to
be a strategy to disrupt sleep or to disorient them.
One detainee reported that he was sleep deprived
for two months in Bagram because his cell was lit with
very strong lights twenty-four hours every day and loud
rock music was played all the time. Another recounted
that he was unable to sleep during his detention in
Kandahar because soldiers were playing very loud rock
music all the time. The use of loud music continued at
Guantánamo. One detainee stated that in Camp Echo
at Guantánamo, he was kept in isolation and he was
exposed to loud sounds. Another who was detained in
block Oscar recalled Guantánamo guards playing very
loud, unpleasant music and banging “every fifteen
minutes” on the doors of their cells.
When the Iraqi former detainees came into US custody
in 2003, this practice was in place as well. One individual
reported being forced to listen to extremely loud music
for many hours at Abu Ghraib, which not only caused
pain but reverberated for hours after it ended; he now

reports hearing loss that he attributes to this experience.
Another former detainee recounted a similar episode in
Abu Ghraib, where he was forced to lie on the ground
while loudspeakers blasted music into his ears at a very
painful volume. Still another stated that in Abu Ghraib he
was subjected to “a very frightening voice” over a stereo
as he was forced to run around in a narrow room with
other detainees for three days. He said: “I thought my
head would explode.” Another former detainee from Abu
Ghraib was forced to dance to loud music that caused him
to hear ringing in his ears for weeks after the incident.
For another Iraqi former detainee, the use of loud music
was combined with sleep deprivation.

Threats of Harm to Detainees and
Their Families
They were telling me, making me hear voices of children and women, and told me they were my children
and [wife].
An Iraqi former detainee
evaluated by PHR
Almost all of the detainees reported being threatened with severe harm, most commonly through verbal
threats during interrogations. Some threats were terrifying claims that the detainee or members of his family
would be killed or severely harmed — or that the detainee
would never be released. One Iraqi former detainee told
PHR that he was led to believe that his family was also in
the prison where he was being held, and that they were
being raped and tortured. Another of the Iraqi participants in this investigation said that the threat against
members of his family was the most painful episode he
experienced while in detention. He recalled, “They were
threatening me, saying they will bring [my] mother and
sisters [here] and . . . rape them.”
US personnel routinely threatened to severely harm
the detainees. One former detainee reported that in
Kandahar prison he was threatened with electric shock,
and in Guantánamo the guards threatened to shoot him.
Another detainee recalled that in his initial interrogations
at Guantánamo, he was asked the same question over
and over again and was threatened that he would “be
forced to tell the truth.” This same individual recalled
that in another episode, an interrogator threatened to
extradite him to his home country where he would be
tortured. Another former Guantánamo detainee recalled
that in one interrogation he was threatened that if he did
not cooperate with the interrogators, he “would stay in
Guantánamo all his life.”
P atterns of T orture and I ll - T reatment   7 9

In Iraq, one detainee reported that he was told he
should write his will for his wife and children and that
he would be executed in two hours. Another Iraqi former
detainee recalled being told by an interpreter, “You will
die here.” A third Iraqi former detainee reported that
while being detained at Baghdad airport, he was threatened with a hammer and told: “we can break your head,”
while another Iraqi former detainee recalled that at Abu
Ghraib, he was poked with a gun that was run up the
length of his body. Another Iraqi recalled that at Abu
Ghraib he was occasionally threatened with death while
he was blindfolded. Two former detainees related that
they were threatened with forced disappearance, since
they were unregistered and were considered “ghost”
detainees. After an estimated twenty-two days in isolation, one Iraqi man recalled being transferred to another
part of the prison for an additional thirteen days. There,
although he was no longer interrogated or mistreated,
he felt threatened since he did not have a prisoner identification number and “expected to be killed.” Another
recalled that he remained in Abu Ghraib for four
months while “no one knew about me [or that] I was in
Abu Ghraib. And when I was in the cell I didn’t have a
number on my hand.”
It is striking that being sent to Guantánamo was itself
used as a threat in Iraq — one heard by half of the Iraqi
former detainees evaluated. One recalled being told he
would be sent to Guantánamo “where you will never see
your family again” and another stated he would be sent
“where even dogs won’t live.” Another reported that he
was threatened during an interrogation that his wife and
daughter would be arrested and sent to “Gitmo” if he
did not talk.
Other threats exploited cultural fears and sources
of humiliation. For example, one Iraqi former detainee
reported that he was photographed while naked and was
threatened that the pictures would be displayed in his
home district.

Instilling Fear Through Use of
Military Dogs
The use of dogs to instill fear among the former detainees
was reported by more than half of the participants in this
investigation. Eight individuals recounted being threatened or witnessing other detainees being threatened or
injured by dogs. For example, one participant recalled
that in Guantánamo during cell searches the guards
would allow the dogs to jump and bark at other detainees

8 0   B roken L aws , B roken L ives

and remembered this as a “very frightening experience.” Another former detainee recalled that guards
in Guantánamo and in Kandahar threatened to unleash
dogs on detainees. A former detainee who had been
threatened by dogs during his detention in Guantánamo
said: “I still see the dogs in my dreams that they are
coming for me and are going to bite me.”
Three former detainees at Abu Ghraib reported that
they were personally threatened with the use of dogs.
One individual disclosed that while he was in Abu Ghraib,
five soldiers descended upon him and threw him on the
floor. They then unleashed a snarling dog on him, while
other restrained dogs surrounded him, barking at his
head. He was not bitten, but saw another prisoner being
bitten. As described previously, another former detainee
reported that in Abu Ghraib dogs were used to frighten
him while he was suspended in a stress position. He
received scratches on his arms and hands, but was
not bitten.

Use of Temperature Extremes
One of the most painful things, when it got cold in
November, they used to put my clothes in the water
and make me put them on, and get me into my room
without any blanket.
An Iraqi former detainee
evaluated by PHR
All of the participants in this investigation reported
being subjected to temperature manipulation, either
through exposure to extreme cold or extreme heat. Cold
water to chill detainees, as well as removal of clothing or
blankets, was apparently used to keep detainees awake
during interrogations, to deprive them of sleep during
detention, and to generally to heighten their sense of
fear and insecurity.
All of the former detainees at Guantánamo Bay evaluated reported conditions of extreme heat or cold during
their detention. One said that upon his arrival in Kandahar,
he was kept in a tent for about twenty days, where it
was extremely hot, approximately 45°C, and he felt very
sick. At Guantánamo, one individual recalled that after
an interrogation session he was moved to the “worst”
section, where he was not allowed to have a blanket or
a mattress. Another detainee stated that upon arrival in
Guantánamo, the detainees were forced to stand outside
while being exposed to the hot sun for five to eight hours.
He recalled asking permission to sit, which was refused

and remembered that some of detainees collapsed from
this exposure to the sun. Similarly, as described previously, another former detainee stated that when he was
in isolation in Guantánamo, his cell was constantly airconditioned and very cold. He recalled that when he tried
to block the air-conditioning vent with a piece of cloth, the
guards would remove it. Another former detainee from
Guantánamo recounted being held in extremely hot or
cold rooms for extended periods of time while ice-cold
water was at times poured over him.
Temperature extremes were also employed during
interrogation. As described previously, another former
Guantánamo detainee recalled that he went through
lengthy interrogations on five days while he was simultaneously subjected to isolation, cold temperatures,
sensory bombardment, and sleep and food deprivation.
The same technique was also used in Iraq. One Iraqi
former detainee described his room at the Baghdad
International Airport as extremely cold, and another was
kept naked in a cold room for the first three weeks of his
detention in Abu Ghraib. Another man held at Abu Ghraib
said that detainees were denied blankets periodically in
the tent area there and were occasionally forced to stay
in the cold as a form of group punishment. Still another
former Abu Ghraib detainee recalled that at times he
was denied clothing or blankets despite cold weather
and/or cold cells.
Cold water was also employed as part of more generalized physical abuse. One former detainee reported
being woken up in Abu Ghraib by cold water being
poured on his head after he fainted during an episode of
harsh physical abuse. Another detainee described that
water was poured on him while he was being beaten
during an episode of interrogation at Baghdad airport,
and recalled thinking he would lose consciousness. A
third Iraqi reported that while in Abu Ghraib, his head
was immersed in cold water on a daily basis. Also, as
described previously, this individual recalled an incident in which he was forced to bathe in cold water while
handcuffed to his bed and forced to stand all night. As
noted previously, another detainee reported that after an
episode of abusive interrogation that included physical
abuse and stress positions, he was put in an extremely
cold room and recalled feeling like “[his] heart stopped.”
Finally, an Iraqi former detainee reported an episode
in Abu Ghraib where he was woken up in the middle of
night and forced to take a cold shower, presumably to
disrupt his sleep.

Beatings and Other Physical Assault
We were beaten every day in Bagram. You cannot
move. If you move, you are punished. Punishment is
suspension to barbed wire for one to two hours.
Former Guantánamo detainee
evaluated by PHR
Aside from the beatings upon arrest and initial detention and transfer described earlier, some of the detainees
were beaten later during their time at Abu Ghraib and
Guantánamo. Three were sodomized at Abu Ghraib.
Three were subjected to electric shock at detention
facilities, two in Iraq and one at Kandahar in Afghanistan.
Many of the physical assaults reported would likely have
resulted in bruises and soft tissue injuries that would
not leave lasting physical marks. However, bone scans
of six individuals as well as scars and healed lesions on
the former detainees, are consistent with the physical
abuse reported. Scarring on one individual’s thumbs is
highly consistent with the scarring caused by electric
shock. Further, reports of rape and sexual assault were
also corroborated by medical examination.

Exploitation of Injuries
Four Iraqi former detainees reported that soldiers deliberately exploited their injuries. One individual recalled
having his already injured hand deliberately stepped
on and squeezed by soldiers in Abu Ghraib. Another
recalled that after refusing an amputation, his right
leg was wrapped in a bandage and a soldier knowingly
kicked him in his injured right leg, making him fall to
the ground. The third detainee reported that an already
existing foot injury was worsened deliberately during an
episode in an unknown prison location, where he and
others were forced to run in a circle in a narrow room.
Despite profuse bleeding, he was forced to continue
running. He recalled that at one point he leaned against
a stretcher and reported his foot injury to the soldiers;
one of the soldiers raised the stretcher sharply, and he
was thrown against a wall, hitting his head, causing him
to lose consciousness. Another detainee recalled that in
Abu Ghraib he was injured when he was pushed down
the stairs by soldiers. This individual recalled that when
he asked a soldier to look at his injured foot, the soldier
hit him on the shoulders, kicked his legs, and ordered
him to stand by the wall.
Another former detainee recounted that soon after
undergoing surgery in Bagram related to injuries

P atterns of T orture and I ll - T reatment   8 1

suffered after a severe episode of beatings, he was
transferred to Kandahar in an abusive manner. Upon
his arrival in Kandahar, American soldiers tied him and
other detainees together with a rope, dragging them
about 200 meters along a rocky pathway. He recalled
that when he screamed because of the severe pain he
was suffering, the soldiers pushed his face forcefully
down on the ground.

Abuse by IRF Teams
Two former detainees at Guantánamo stated that they
had endured abuse by guards whom they referred to as
the “riot police,” which were most likely members of
the Immediate Reaction Force (IRF) teams. One former
detainee recalled that even after minor infractions,
“robocops” dressed in riot helmets and padded uniforms
would come and beat the detainees. This individual
stated that these beatings happened on a regular basis
and would include kicks to the back, legs and head. He
also reported that guards beat him for infractions like
hiding food in his cell or speaking with other detainees.
Additionally, he recalled that the IRF team used an irritant spray that caused severe pain in his whole body,
“Sometimes I felt like I was losing consciousness from
the burning.” Another former detainee recounted the
brutal force and harsh treatment utilized by the “riot
police” at Guantánamo. He said that a female soldier
subjected him to a chemical spray and assaulted him
with an industrial strength hose that left him “writhing
on the ground in pain.”

Use of Electric Shock
Three detainees reported being subjected to electric
shocks during their detention. One Iraqi former detainee
said that in combination with sexual humiliation, electric
shocks were administered to his private parts. The third
individual reported suffering extremely painful electrical
shocks on three separate occasions during his detention in Abu Ghraib. “I felt that my eyes would go out or
blow, and I feel my teeth, and one time I bit my tongue…
when they shock you with electricity it feels like your
eyes will explode.” One detainee said that in a Kandahar
prison he was purposefully pushed into a generator that
shocked him. None of the detainees reported having been
subjected to electric shock in Guantánamo Bay.

Beatings During Detention
Beatings and physical abuse continued beyond the first
weeks of detention in Iraq. One Iraqi former detainee
described an incident of physical abuse in Abu Ghraib
where he was kicked in the chest and abdomen, and
8 2   B roken L aws , B roken L ives

on another occasion he was pulled on the stairs. He
described other incidents in which he was struck with a
rifle in the head and right jaw while laying on the ground
and also recalled an incident when a soldier stabbed him
with a screwdriver in his cheek, causing intense pain and
bleeding. In another instance, an interpreter kicked him
in the nose, causing bleeding. On two other occasions,
a soldier jumped from a table onto his right thigh and
another soldier stamped on his right big toe, causing
severe pain which persists to this day.
Yet another Iraqi individual reported being punched
and kicked frequently during interrogations in Abu Ghraib
and at an unknown prison location. He also recalled his
chest being burned by a cigarette during an interrogation
session in Abu Ghraib and receiving hard slaps over his
ears, causing considerable pain.
Another Iraqi former detainee also reported several
episodes of physical abuse. In one instance, during interrogation sessions in an unknown prison location, his
head and body were repeatedly pushed into the wall. In
another episode in Abu Ghraib, he said that an interpreter
hit him on the nose with a plastic water bottle, causing
bleeding. He believed his nose was broken as a result of
this assault. During interrogation sessions in Abu Ghraib,
he recalled being hit and kicked, losing consciousness on
one occasion from a severe blow to his head.
Likewise, another detainee also reported episodes
of physical abuse in Guantánamo after the initial period
of detention. He said he was beaten frequently. He
recounted that while being held in isolation in Camp
Oscar at Guantánamo for five days, guards tried to
remove his shirt and shorts by force and after he
resisted, soldiers pushed him against the wall, causing
his head to bleed. He also stated that while detained at
Guantánamo, an interrogator tied him to the ground,
threatening him and shouting. The interrogator then
pressed on his throat to the point of choking and hit
him in the chest and the jaw.

Sexual Assault and Attempted Sexual Assault
Several Iraqi participants recalled incidents of sexual
assault, most of them occurring in Abu Ghraib. One
Iraqi former detainee reported that during one abusive
episode in Baghdad airport he was beaten severely and
the soldiers pulled his penis and testicles, causing severe
pain. Another Iraqi man described an attempted rape
while he was in Abu Ghraib prison. Late one night, a
soldier approached him in a threatening manner with
the intent of sexually assaulting him, according to the
former detainee.

Two detainees described being sodomized at Abu
Ghraib. One reported that guards took him to a small,
foul-smelling room, where they forced him to lay down
in urine and feces, while shouting into his ear through
a loudspeaker. They then forcibly inserted a broomstick
into his anus while he was hit and kicked in his back
and on his side repeatedly. He recalled that he was
bleeding from his feet and shoulders, and the urine on
the floor with which he came in contact exacerbated the
pain from these wounds. During this time he recounted
being pulled by a leather dog leash and being forced to
howl like a dog. He explained that if he did not respond,
the soldiers would kick him. He recalled that he felt a
hot liquid on his back and believed that someone was
urinating on him. He was kicked again, this time in his left
side and in the groin, and one of the Americans stepped
on his genitals, including his testicles and penis, which
caused him to lose consciousness.
The other detainee recalled an episode at Abu Ghraib
where he was chained, kicked repeatedly as he went up
a staircase, and when he reached the top of the stairs,
“The party began…They started to put the [muzzle] of
the rifle [and] the wood from the broom into [my anus].
They entered my privates from behind.” This individual
estimated being sodomized five to six times during this
abusive incident and saw blood all over his feet.
Another Iraqi former detainee described being threatened with sodomy on several occasions but said he was
not sodomized, although the evaluators suspected that
he actually had been.71 In one instance at Abu Ghraib, a
soldier that “had a stick in his hand [that he] was trying
[hard] to insert in my [anus]…but I was saying that I will
kill myself if you do these things” and screaming loudly
“like crazy people,” which in the detainee’s view may have
prevented him from being raped.

Sleep Deprivation
If you ask me about being chained to the window
[standing], it was every day. They were especially
doing that at night, to prevent me from me sleeping.
Iraqi former detainee
evaluated by PHR
Nine of the eleven former detainees evaluated reported
being subjected to sleep deprivation in combination with
other techniques. As described earlier, US personnel
Although this individual denied anal penetration, the evaluators
found scars highly consistent with anal trauma. The medical experts
concluded that these scars raise the possibility that, despite his
denial of anal penetration, it may have actually have taken place.

71  

prevented the detainees from sleeping by playing loud
and sometimes deafening music, throwing cold water on
detainees, keeping very bright lights on during the night,
and banging on the bars of cells. Other detainees were
kept in stress positions, preventing sleep.

Sexual, Religious, Cultural, and Other
Forms of Degrading Treatment
They called me [Tarzan], because I had the toothbrush
in my hand and I was naked like Tarzan, who held a
knife and was naked. The interpreter explained this
to me in detail.
Iraqi former detainee
evaluated by PHR
Systematic sexual, religious and cultural humiliation and degradation were reported by all of the former
detainees evaluated by PHR.

Cultural and Religious Humiliation
US personnel subjected more than half of the individuals evaluated to cultural and religious humiliation. In
one case, an Iraqi former detainee stated that soldiers
removed his egal (Arab headpiece), and kicked it after it
fell to the ground. Another man reported that soldiers in
Guantánamo would yell and taunt detainees during the
call to prayer, while another stated that at Guantánamo
he witnessed soldiers desecrating the Koran, ripping
it apart or writing offensive words on the pages, and
occasionally stepping on it. One Iraqi former detainee
reported having been called “girl” in Arabic. Another
former detainee described a number of occasions during
cell searches at Guantánamo where guards stamped on
the Koran with their feet. He recalled that the detainees
in all five blocks of Guantánamo organized a simultaneous uprising to oppose such practices. He stated that
the detainees banged their heads against the walls and
demanded “an end to the mocking of their religion.” Yet
another participant reported that while in Bagram, the
guards did not let the detainees pray together, which he
stated as being very important for Muslims and added,
“They didn’t let us recite the Koran. They threw the Koran
into the toilet in front of us.” 

Humiliation and Degrading Treatment
Eight participants recounted experiencing various additional forms of degrading treatment in combination with
other techniques described above. Two Iraqi former
detainees recalled having been spat upon. Another
recalled that soldiers in Abu Ghraib wrote degrading
P atterns of T orture and I ll - T reatment   8 3

phrases in permanent marker all over his body. Yet
another recalled that soldiers in Abu Ghraib called him
“Tarzan” and pasted the nickname on his cell door for six
days. This individual was pulled by a leather dog leash
at Abu Ghraib and was ordered to howl like a dog; he
suspects that soldiers also urinated on his back. Another
reported being forced to drink the urine of soldiers. When
asked about this incident, he stated, “I died at that time…
after that I could not eat anything.”
Many individuals evaluated described feeling humiliated by being observed naked or while using the toilet.
One Iraqi former detainee recalled that on one occasion
an American soldier forced him to defecate in front of
him. Yet another Iraqi former detainee recounted having
the sides of his head shaven, solely so the soldiers could
laugh at him.
Humiliation was pervasive at US facilities in
Afghanistan as well. One detainee recalled that his beard
and head were shaved forcibly three times while he was
in Bagram. Another former detainee stated that upon
arrival in Kandahar, female soldiers sat on the detainees,
took photographs, beat them on the head, and humiliated
them by laughing at them and offending their religion.

Sexual Humiliation
Sexual humiliation was reported by virtually all of the
individuals evaluated by PHR. The beatings detainees
experienced at facilities in Afghanistan were accompanied
by sexual humiliation. One detainee stated that during his
transfer from Bagram to Guantánamo, he was touched
in a humiliating manner; he would not elaborate further
but said he considered it the worst experience during his
four years in detention. The detainee also recalled that
in Bagram he was forced to shower with other detainees
and kept naked several times: “It was very shameful for
us.” As described previously, this individual noted that
upon arrival at Bagram airport, detainees were forced to
strip off all of their clothes and if they refused, they would
be beaten. Similarly, another former detainee described
that upon admission to the Kandahar prison, his clothes
(and those of fellow detainees) were cut off with scissors
in front of female soldiers.
Sexual humiliation continued at Guantánamo, especially during interrogations. One man stated that when
he refused to cooperate with one interrogator, a female
interrogator began acting in a sexual and provocative
way toward him. He stated that this was a very shameful
experience for him and very hard to tolerate. Another
detainee reported an extremely upsetting and humiliating
episode in Guantánamo during which he was forced to
8 4   B roken L aws , B roken L ives

watch pornography and witness naked men and women
appearing to have intercourse. He also described an
incident in which a woman entered the interrogation
room naked and smeared blood that he believed to be
menstrual blood on him, and he described this incident
as horrifying.
At Abu Ghraib, detainees were often kept naked,
sometimes for weeks at a time, and some described
sexual humiliation during interrogation sessions. One
recalled that his genitals were touched multiple times
by soldiers and that he was photographed naked, which
made him feel especially humiliated and ashamed.
American soldiers threatened to send the photos to his
home district. Another Iraqi former detainee reported
that he was stripped to his underwear when he was first
interrogated at an unknown prison. He was kept naked
for three days while he was forced into stress positions,
and his genitals were touched by guards. He recalled that
in one incident at Abu Ghraib his underwear was taken
off and he was forced to pose in humiliating positions so
“they can take photographs….They were trying to make
me look like an animal.”
A third Iraqi former detainee recounted that upon his
arrival at Abu Ghraib and during his first interrogation,
his clothes were forcibly removed. As described previously, he was kept in a dark, windowless, cold room,
naked, for about fifty days. During this time, he reported
the recurrent practice of being forced to stand naked and
hooded outside of his cell for several hours. This individual further described being forced to wear a woman’s
undergarment on one occasion. He also recalled being
shown photographs of naked prisoners by the soldiers.
Similarly, another Iraqi former detainee recounted
being forced to strip naked while being photographed
by US officials in an unknown detention location. He
reported that on a separate occasion he was kept naked
in his cell for four days and that he resorted to praying
while naked, even though he explained that nakedness is
forbidden. He noted that the soldiers would come to his
cell and humiliate him because of his nakedness.

Witnessing Torture and Cruel
Treatment
[The interrogators] wanted me to see my brother
[being] humiliated like me…I saw his head bleeding…
his hand broken…he was naked…with a piece of fabric
covering his private parts.
Iraqi former detainee
evaluated by PHR

More than half of the former detainees evaluated
by PHR recounted witnessing torture and other cruel,
inhuman or degrading treatment inflicted on other
detainees. One individual stated that he witnessed his
brother being abused at Abu Ghraib. Another Iraqi individual detained at Abu Ghraib recalled hearing highpitched screaming from “others who were tortured,”
while he was being suspended in a stress position. Two
of the individuals evaluated, one who was detained at Abu
Ghraib and the other at Guantánamo, reported that they
witnessed other detainees being bitten by dogs.
Three of the former detainees reported having
witnessed other detainees being subjected to various
forms of sexual humiliation. One reported that while at
Abu Ghraib he witnessed soldiers forcing Iraqi men to
lie naked on top of one another. The two others noted
that they witnessed US personnel at Abu Ghraib forcing
naked prisoners to form a human pyramid. These two
individuals both recalled seeing detainees being forced to
simulate anal intercourse. “For more than half an hour”
one was forced to watch the naked detainees being forced
to enact anal intercourse by being pushed into each other.
Watching them caused him overwhelming “embarrassment” and terror. Another Iraqi former detainee reported
witnessing the sexual humiliation of other prisoners
who were forced into positions where their genitals
would touch, as well as positions that simulate anal
intercourse.

Health Professional Complicity and
Denial of Medical Care
Some of the detainees reported that they received
good and appropriate medical care during their detention. However, both the experiences recounted by the
detainees and the medical records available in one of
the cases show how physicians and other health workers
became, at best, ethically compromised in these detention settings. At worst, health professionals at these sites
became enablers of torture by providing medical care
in an environment where torture was taking place. In
fact, in some cases health professionals may have given
interrogators the ”green light” to continue with abusive
techniques and, in other cases, the health professionals
effectively patched the detainees up so that they could
be abused further.
One detainee who was tortured during his initial
detention in Baghdad Airport stated that he received
medical attention shortly after arriving at Abu Ghraib:
“[The doctor] helped me … he told the soldiers, ‘If you go

on torturing him in this way, he will die.’” One detainee
noted that he was diagnosed with tuberculosis and was
given medications. He also reported that he received
care for constipation and gastric pain. Another former
detainee reported that he received medical attention
for his stomach pain, headaches, and other problems
just before being released from Guantánamo. Another
former detainee stated that during his detention in a
special medical block, there was a female “psychological
commander” who prohibited the soldiers from harassing
the detainees.
Access to care, though, was sometimes difficult. One
detainee stated that during his detention in Guantánamo,
he suffered pains in his ears, and despite his requests
he did not have an examination nor was he given any
medication. Another reported that despite his “many,
many” requests for medical attention for persistent
stomach pain, as well as for swelling in his wrists, he
never received care.
In Iraq, the availability of professional and humane
care was far worse. Although there was an exceptional
case — a detainee noted that a surgeon respected his
refusal of a recommended amputation of one of his feet
and reported that he received “humane treatment from
the doctor” after developing an infection on his foot —
the detainees reported that even accessing medical care
was very difficult.72 The very detainee, a diabetic, who
complimented the performance of the doctors, had difficulty getting the care and medication he needed. He was
given insulin during his first day of detention but was
later denied additional medication and believes that the
refusal was due to a perception that he was not cooperating with officials. Moreover, during his detention in
the communal tent area of Abu Ghraib, his foot and leg
problems persisted, and he had to ask to see a doctor
more than ten times before he was referred for care,
and only when the ICRC intervened was he transferred
to a hospital.
Several other men at Abu Ghraib reported being denied
needed medical treatment, including for injuries inflicted
by soldiers (e.g., shards of glass in feet from a violent
arrest and a foot injury from being pushed down a set of
stairs by soldiers). In the latter case, the soldiers simply
told the detainee to “shut up.” His foot was swollen and
The detainees’ accounts in this respect are consistent with a report
of the US Army Surgeon General confirming that health care in
Iraq was chaotic in the early years of the occupation. Office of
the Surgeon General, U.S. Army, Final Report: Assessment of Detainee
Medical Operations for OEF, GTMO, AND OIF (2005), available at http://
www1.umn.edu/humanrts/OathBetrayed/Army%20Surgeon%20
General%20Report.pdf.

72  

P atterns of T orture and I ll - T reatment   8 5

bruised, and it took approximately six weeks for the
swelling to subside. He was not provided with crutches,
a cane, or any medical care until he was transferred to
the communal tents at Abu Ghraib, where he was able
to use a stick to walk.
Questions of quality and access, however, do not fully
encompass the very problematic role health professionals played, especially at Guantánamo. Even those
health professionals who sought to restrict themselves to
clinical roles and steered clear of interrogation support
became part of the machinery of torture. PHR has no
information about whether physicians or other health
personnel reported torture to authorities, but they surely
did not intervene to stop torture when they were in its
midst or were examining those subjected to it. Moreover,
in the one case where medical records are available, it
is apparent that the health staff provided pharmacological treatment for suicidal, self-destructive, and partly
psychotic behavior that is at least partially attributable
to the torture — including isolation —the detainee experienced, yet the health providers only marginally intervened to stop his torture.
Nine former detainees evaluated reported that health
professionals examined their condition during an episode
of torture or physical abuse but, as far as the detainees
could tell, made no effort to stop it. One man stated
that during his initial interrogation at Baghdad airport
someone who seemed to be a doctor was present to
monitor his heart and blood pressure. The detainee was
suspended in the air, which caused his arm to dislocate. The person whom the detainee surmised to be a
doctor put his arm back in its place and then informed
the interrogators that they could “continue.” A detainee
at Abu Ghraib reported that after having electric shock
administered, he passed out on the floor. He remembered
gaining consciousness as a person whom he believed
was a doctor revived him and appeared to grant permission for the interrogators to continue. He also recalled
that despite repeated requests for medical attention for
his hand, he was only given one tablet daily for pain.
At Guantánamo, two detainees said that a person who
seemed to be a doctor was present during beatings in
Guantánamo Bay. Detainees also suspected that medical
and psychological information gained from the detainees
for treatment was shared with and used by interrogators. Three of the former Guantánamo detainees said that
they spoke with psychologists. Although the men initially
thought the meetings were confidential, they later had
reason to believe that the psychologists shared information with interrogators.
8 6   B roken L aws , B roken L ives

The detainees from Guantánamo reported that they
were given injections or medication without their consent.
For example, one man recalled receiving an estimated
ten to fifteen injections that often caused rashes. He also
indicated that sometimes the injections were administered by “civilians…coming to take lessons — it was
like internships.”
The medical record available for one detainee sheds
special light on torture, the impact of torture, and the
treating health professionals’ response to the clinical
signs and symptoms. After having been beaten, held in
stress positions, and kept in isolation in Guantánamo
for three or four weeks after his arrival, the detainee
started showing severe symptoms of mental distress. He
attempted suicide, repeatedly banged his heat against
the wall, was defiant, and, at some points, hallucinated.
Although there is ambiguity about the degree to which
the detainee exhibited psychopathology and the degree
to which he was rebelling, mental health staff identified
psychiatric conditions and gave him significant doses
of psychotropic medication, which had significant side
effects, but did almost nothing to address the origins of
his severe distress. Although they acknowledged that
isolation worsened his condition and recognized his
constant begging to be placed in be in a cell with someone
who spoke his language, the record indicates that they
only intervened once, three months after his symptoms
appeared, and his reprieve lasted only a short while. In
doing so, they became complicit in his torture, essentially patching him up in order for him to be subjected to
further ill-treatment.
Moreover, PHR evaluators concluded that the health
professionals clearly failed to adequately evaluate, document, or treat severe psychological symptoms and their
behavioral manifestations, particularly post-traumatic
stress disorder. Finally, despite multiple incidents of
self-injurious behavior and suicide attempts by the
individual, including banging his head against a wall,
attempted hanging, and participating in hunger strike,
psychiatrists list “routine stressors of confinement” as
part of their findings in diagnosing the detainee. In doing
so, they disregarded cruel or ill-treatment as a likely
cause of these symptoms. This is reinforced by the fact
that when torture ended in the last years of his confinement, so did his symptoms of mental illness. In sum,
the health professionals were complicit in the torture
of this detainee.
The medical records do not indicate that the health
professionals inquired into or documented any form of
ill-treatment perpetrated by US soldiers. Instead, their

interventions and documentation obfuscate the relationship between the detainee’s abuse and ill-treatment in
confinement and his deteriorating mental and physical
condition.

Response by US Personnel to ICRC
Visits
Three of the former detainees evaluated for this report
mentioned that a representative of the International
Committee of the Red Cross (ICRC) visited them during
their detention. One man reported that while he was
being kept naked in Abu Ghraib, representatives of the
ICRC visited him, and he told them about his ill-treatment. He stated that the ICRC personnel provided him
with clothing and blankets but that these items were
confiscated after they left. Before the ICRC returned the

following day, these provisions were given back to him,
only to be taken away again when the visitors were gone.
ICRC representatives visited another former detainee
in Abu Ghraib after an infection in his foot had worsened
to the point where he could not stand. This individual
believed that because of ICRC intervention, he was transferred to a hospital. Another participant reported that
six months after his arrival to Guantánamo he received
a letter from his family via an ICRC representative and
was then allowed to send letters to his family every six to
eight months. This former detainee reported witnessing
another detainee being punished with one month of isolation because he had kept an apple in his cell and recalled
that when he reported this to the ICRC, the detainee was
punished with an additional month of isolation after the
ICRC had left the camp.

P atterns of T orture and I ll - T reatment   8 7

8 8   B roken L aws , B roken L ives

V. Short-Term and Lasting Harm
from Torture and Ill-Treatment

A

ll of the detainees suffered severe physical
and mental pain as a result of the assaults
on them by US personnel. The pain was often
searing at the time it was inflicted and, for most of the
detainees, continues to this day in the form of deep
physical discomfort and/or severe mental anguish,
which includes depression, anxiety, and post-traumatic
stress disorder (PTSD).

Acute Impact of Ill-Treatment
All former detainees evaluated by PHR recalled experiencing excruciating physical and emotional pain during
the infliction of abuse upon them by American personnel.
Most, if not all, former detainees lost consciousness at
some point during an episode of ill-treatment, either as
a result of direct head trauma or overwhelming pain. One
former detainee was beaten so severely during an interrogation in Bagram, Afghanistan that he lost consciousness and subsequently required surgery. Soon after the
surgery he was transferred to Kandahar and though
weak, he was hooded and shackled, with his knees taped
together in a kneeling position while tied to the floor.
Later, he was forced to walk along a rocky pathway while
he was suffering from excruciating abdominal pain.
The individuals evaluated by PHR suffered acute and
severe physical pain from practices including being made
to walk or run while injured, or being physically attacked
with a variety of implements, such as being stabbed in
the cheek with a screwdriver; and some former detainees
suffered excruciating pain from being kicked, punched,
choked, or sodomized. Three former detainees suffered
immense pain from the intentional application of electric
shocks. Other former detainees reported severely painful
swelling or bruising of the genital region due to physical assault. Another detainee recalled suffering from
nausea and vomiting and saw blood in his urine during
his initial detention at Guantánamo. Six of the former
detainees reported suffering chronic headaches while
in US custody. Many of the detainees suffered muscular
pain in their necks, arms, and backs that lasted long

beyond when they were forced into painful suspended
and stress positions for prolonged periods.
They all experienced terror — of being attacked by
dogs, of being physically beaten, shocked or sodomized again, of threats to themselves or their families
or to be sent to their home country where they would
be tortured, or by witnessing or hearing abuse being
inflicted on others. And they all experienced the acute
shame and pain of severe sexual, cultural, and religious humiliation. Being kept without clothing in a
dark, claustrophobic cell for extended periods of time
caused anxiety attacks as well as emotional trauma
in many of the former detainees. One former detainee
reported chest pain and shortness of breath when he
became nervous, and another reported severe emotional
trauma from sustained, repeated sexual abuse. Several
detainees reported not being able to sleep, and one
stated: “I was having really bad nightmares…I felt like I
couldn’t breathe.” According to medical files, during an
interrogation session in Guantánamo one detainee had
a seizure and “was unresponsive and fell …[while] his
feet [were] buckled.”
All former Guantánamo detainees reported receiving
multiple injections against their wishes. One reported
that he often developed rashes several hours after these
injections (“red dots on my body and shoulders that
would start to itch”). Another suffered from the physical
and mental consequences of forced injections that not
only caused joint and skin pain, but also memory loss and
shortness of breath. He recalled that the injections made
him “lose [my] mind…and brought [me] to [my] knees.”
Seven of the eleven individuals evaluated disclosed
having contemplated suicide as a result of the abuses they
suffered while in US custody. Suicidal ideation is particularly significant and pathological in these cases given the
strict prohibition against suicide in the Muslim religion,
to which many of the detainees adhered. Nevertheless,
two individuals described being so desperate while at
Guantánamo that they tried to kill themselves by banging
their heads against a hard surface. Another participant
stated that he constantly harbored suicidal ideation
  89

but adhered to the teachings of Islam, which prohibits
suicide. Another detainee similarly described invoking
his adherence to Islam, despite wishing to die while in
Abu Ghraib. Further, he added that “there was nothing
to kill myself with.” Another individual acknowledged
that “inside the jail, I did pray to Allah to make me die.”
Similarly, one participant recalled his darkest moments
while in Guantánamo when he thought “Satan” would
tempt him to commit suicide, but he adhered to Islamic
rules. For another individual the isolation, beatings, and
other abuse he experienced in Guantánamo had a severe
impact on him, causing his mental condition to seriously
deteriorate. According to his medical records, this former
detainee had audiovisual hallucinations and was diagnosed with a major depressive disorder and psychosis.
He was treated with psychopharmacological drugs that
were associated with severe side-effects. However, the
lengthy interrogations, isolation, and sleep deprivation
to which he reported being subjected continued. During
this time, he engaged in several acts of self-harm such
as self-mutilation, attempted hanging, ingestion of the
liquid in ice packs, which contains ammonium chloride,
and banging his head against the prison walls. According
to his medical files from the first year of his detention
at Guantánamo, he also participated in a hunger strike,
saying to the officials, “Either send me home or prosecute me.” Yet the abuse and ill-treatment continued.

Chronic Physical Consequences of
Ill-Treatment
All of the individuals evaluated by PHR reported that after
their incarceration they suffered from headaches ranging
from occasional to chronic, occurring as often as three
times a day or lasting up to three hours at a time. While
the etiology of headaches cannot be definitively determined, these reports were highly consistent with a history
of head trauma. Continued psychological symptoms and
emotional distress may contribute to these headaches
as well. One detainee also reported hearing loss, which
he believed was due to the loud music that was blared
at him in Abu Ghraib.
All of the former detainees examined by PHR reported
that they continue to suffer from diffuse musculoskeletal pain that they did not experience prior to detention. Many of the persistent pain reported, as well as
the descriptions of the abuse that caused these injuries,
were supported by findings from the physical examination. However other reported pains of unknown etiology
and with no identifiable organic basis may be psycho9 0   B roken L aws , B roken L ives

logical in nature, possibly indicative of trauma-induced
somatization disorder, described below.
Many former detainees reported significant persistent pain in their limbs, joints, muscles, and ligaments,
as well as functional impairments that, as the individual case reports reveal, can be attributed to injuries
sustained during episodes of physical abuse. One individual reported arm numbness and weakness following
suspension by his arms, which is highly consistent with
a brachial plexus injury often resulting from the type of
suspension he described enduring. Since his release
from Abu Ghraib prison, he has been suffering from
chronic pain in his neck, legs, right shoulder, and feet, all
of which he attributed to, and are consistent with, reports
of injuries sustained during his incarceration (e.g., beatings, being suspended in stress positions).
Another man experiences daily lower back pain
and numbness in his legs that began while he was in
Guantánamo and is exacerbated by lifting heavy objects
and walking. This type of injury is consistent with his
report of being subjected to shackling and handcuffing
for extended periods of time. Similarly, the diffuse lower
back pain that another former detainee described is
consistent with his report of beatings to the back. Further,
the significant right shoulder pain and functional impairment another individual reported is consistent with a
shoulder injury resulting from suspension.
One former detainee’s spondylarthrosis and discopathy at the level of second and third lumber (L2-L3)
vertebrae73 is consistent with prolonged restriction of
movement, prolonged exposure to cold temperatures,
and being shackled in painful positions for long periods
of time. The pain this individual suffers when moving
his right knee is consistent with having been subjected
to restriction of movement and the trauma to his knee
that he reported during his detention in Guantánamo. The
same detainee reported suffering from chronic constipation, which can occur as a secondary symptom of several
stress conditions and also because restriction on mobility
of inadequate intake of fluids and food which he reported
intentionally limiting to avoid having to use an open toilet.
The chronic constipation may also represent a psychosomatic manifestation stemming from the several forced
anal cavity searches reported by this individual. Also the
diagnosis of external ear infection and thinning of the
eardrum is consistent with a history of the beatings to
the head, which the detainee had reported sustaining
in detention.
For an explanation of the spondylarthrosis and discopathy, see supra
notes 51-52.

73  

Lasting Psychological Consequences
of Ill-Treatment
Ten of the eleven individuals’ clinical presentations,
reported history, and the results of their psychological
testing supported the presence of ongoing psychiatric
disorders that can reasonably be attributed to their experiences while in detention at US facilities.	

Major Depressive Disorder
Severe depression is one of the most common longterm consequences of torture. The clinical presentation
and the results of psychological testing indicated the
presence of major depressive disorder among seven of
the participants examined. Many detainees suffer from
symptoms such as feeling hopeless and isolated, and
feeling that they have no future. One participant reported
that he cannot remember the Koran very well and he
has no desire to read it as he did before. The depressive symptoms appear directly related to the multiple
traumatic experiences these men described. In one case
these symptoms were exacerbated by a pre-existing
depression and became disabling and chronic after the
detainee’s incarceration.
The severity of these depressive symptoms varies
considerably among the former detainees. One man has
an extremely severe depressive disorder that, according
to the evaluating clinicians, warrants psychiatric hospitalization. Three other participants were diagnosed with
major depressive episodes that appeared to be directly
related to the multiple traumatic experiences they
described. Another former detainee’s symptoms indicate
moderate levels of depression that warrant mental health
treatment. Finally, another individual who had significant
coping resources had only a mild level of psychological
maladjustment that did not reach a clinically significant
level and did not seem to impair his functioning.

Post-traumatic Stress Disorder
After their release, all except one of the interviewees
showed symptoms that meet the diagnostic standards
of all three clusters of PTSD symptomology, including
intrusive recollections of the trauma, hyperarousal, and
avoidance and emotional numbing behavior. These symptoms can be directly traced to the traumatic experiences
the detainees reported.
Flashbacks and intrusive memories provide important evidence that the symptoms displayed by an individual are in fact attributable to an identifiable cause.
Moreover, unlike many symptoms such as headaches
or depressed mood, flashbacks and intrusive memories

are rarely attributable to minor stressors or pre-existing
psychopathology. Suffering from flashbacks and intrusive memories preoccupied the days of all of the former
detainees examined by PHR. “It is like in my head I have
never left Abu Ghraib,” one of the former detainees told
PHR. For one man, the intrusive thoughts and memories
of the traumatic events were particularly related to the
sexual humiliation he had endured. Another reported
having occasional nightmares in which he is attacked by
dogs, and one reported re-experiencing the traumatic
events he endured both in his dreams and while awake.
One former detainee is constantly haunted by the memories of the trauma and tries to avoid triggers that remind
him of Guantánamo, like avoiding people with uniforms
when he is in the public. Another man said, “These are
the memories I can never forget…I want to forget, but it
is impossible.”
Avoidance and emotional numbing behaviors such as
anhedonia (the loss of interest in previously pleasurable
activities), resulting in feeling estranged from others,
were also commonly reported. One former detainee
described having trouble being naked in front of his wife,
avoiding open spaces, people, and social activities as
well as feeling flat or constricted in his emotions. He
explained, “Maybe I feel about one quarter of my feelings.” Another former detainee noted that he has moved
from his home “because my home reminds me of what
happened.” Similarly one man left his home region in
order to avoid frequent reminders of his imprisonment.
Nonetheless, he noted, “How can I forget this?”
Hyperarousal symptoms such as concentration difficulties, outbursts of anger and irritability, as well as
sleep difficulties and hypervigilance were also commonly
reported by the men evaluated. In the case of one of the
former detainees who reported significant depressive
symptoms prior to his incarceration, the nature of his
intrusive memories and avoidance behaviors suggested
that his experiences during incarceration had substantially exacerbated his psychological difficulties.

Anxiety Disorders
Many former detainees described symptoms indicative
of intense anxiety, including occasional panic attacks
warranting mental health treatment. For many, these
attacks were typically triggered by thoughts about the
trauma endured and were characterized by chest pain,
shortness of breath, tingling in the hands and feet, and
numbness. One man characterized the chest pains as
“feeling a sudden crisis in my heart” that occurs “more
often when I’m stressed” and another described it as “a

S hort - T erm and L asting H arm from T orture and I ll - T reatment   9 1

stab in my heart.” Another participant reported starting
to panic when somebody walks behind him and that he
often feels people are looking at him, which makes him
think that he is not normal. He stated that he is also
nervous and he gets irritated about minor problems.

Somatization
Although it is always difficult without long-term observation and extensive medical diagnostic evaluations
to conclusively attribute physiological symptoms to a
psychogenic origin, the extensive literature on PTSD in
general and in survivors of torture in particular is consistent with the attribution of many of these symptoms to
somatization. Physical complaints with no identifiable
organic origin are common in the context of PTSD and
often reflect psychological distress rather than physical
illness. All except one of the former detainees evaluated by PHR were diagnosed with somatization disorders.
Reported somatization symptoms included dizziness,
nausea, and numbness, difficulty breathing, rashes, and
chest pressure.

Sexual Dysfunction
More than half of the eleven individuals reported persistent sexual dysfunction. Sexual dysfunction can be due
to both physical and psychological factors, but many of
the descriptions of sexual dysfunction reported by these
detainees, such as erectile dysfunction, low sexual drive,
and minimal desire and interest in sex are consistent
with a history of sexual violation. One man described his
inability to be fully naked in front of his wife. He further
explained that he was traumatized that female soldiers
had seen him naked and that his genitals had been
exposed, scrutinized, commented upon, and ridiculed
by a group of strangers. For another former detainee,
flashbacks of his torture, especially the sexual aspects,
would often intrude during sex with his wife. In such
instances, he would then “lose all strength.”

Smoking and Alcohol Abuse
Two men reported a dramatic increase in their alcohol
consumption following release. One individual stated
that he has increased his cigarette smoking considerably
from approximately one pack per day before his arrest
and detention to nearly two packs per day, explaining,
“I feel more relaxed when I smoke.” One individual
stated that he has been drinking alcohol on a daily basis
since his release despite religious prohibitions against
alcohol and that he feels irritable, uncomfortable, and
has noticed hand tremors and jitteriness when he wakes
in the morning. This individual stated, “After I got out
9 2   B roken L aws , B roken L ives

from the prison I started drinking a lot — every time I
was always feeling that I want to get rid of these pictures
from the prison that I have in my mind…I cannot sleep
without alcohol or some Valium.”

Diminution of Social and Work Life
After Detention
After I got out, I found my home totally broken, I
found my wife blind [from injuries sustained during
my arrest], and my children are not good at their
schoolwork any more. No one could look after them
well — no one helped them. They were very poor, they
were desperate. They even could not find a door that
could close the home [after the Americans destroyed
it during my arrest] — for three month[s] our home
was open.
An Iraqi former detainee
evaluated by PHR
With one exception, all of the former detainees
described profound life difficulties and disruptions after
their release from detention. The exceptional case is an
Iraqi former detainee who was subjected to the least
egregious treatment while in US custody. After release
this individual quickly reintegrated into civilian life,
regaining his status in his community, resuming and
enjoying the leadership of his large family. He was not
subjected to any further difficulty with the authorities and
received sympathy from people regarding his arrest and
imprisonment. All others suffered enormous difficulties
trying to resume normal life and reintegrate into their
families and communities after their release.

Social Relationships and Stigma
Many former detainees reported a change in their family
relationships upon their return home after detention in
US custody. One individual stated that he became very
concerned that his wife and children were afraid of him and
as a result of this concern he began living with a brother.
He only has visited his family once a week because he
believes his visits make them uncomfortable. One man
explained he felt that his family has been shattered and
that he caused much calamity to befall them because of
his detention. Another individual emphasized not wanting
his children to know about his experiences in detention:
“I want to stay strong in their minds. I don’t want to ruin
my reputation with them.” Within his immediate family,
only his wife knows about the extent of the detention
ordeals, and as a general rule, the topic of Abu Ghraib is
not mentioned between them. Similarly, another former

detainee who had many friends before his incarceration noted that he has become more isolated since his
release from Guantánamo. This individual further stated
that he moved out of his hometown to avoid discussing
his detention experiences with his friends and family.
Two former detainees reported feeling lonely, isolated,
and abandoned in their new places of residence. They
both described feeling completely uprooted and without a
social support network, including their families. Another
reported that his personality has changed, he is extremely
irritable, and he has lost his trust in people. Although
another former detainee remains estranged from his
family, he has become involved in human rights activism
since he has moved to another country and works with
other Iraqi refugees and torture survivors.
Most detainees expressed that they have lost their
status in their community and carry the stigma of being
a former US detainee. One expressed his deep belief that
he was a “marked man.”

Employment
Many individuals evaluated by PHR described feelings of
helplessness, shame or guilt because of their inability to
protect or provide for their families.
The war in Iraq has shattered the country’s infrastructure and deprived Iraqis of basic security. Thus, examining the impact of detention and torture on the livelihood
of the Iraqi men evaluated is confounded, of course, by
the devastated condition of the country in which they
live. Men detained at Guantánamo Bay were not from
Iraq and so their vocational functioning can be more
easily assessed.
All the former Guantánamo detainees reported losing
their employment or being in a precarious financial situation as a result of their detention. All former Guantánamo
detainees reported having been unable to find employment since release. Yet another former Guantánamo
detainee reported having difficulty functioning in work
environments since his release, due in large part to his
psychological problems (e.g., PTSD, panic disorder).
Iraqi individuals reported economic struggles and an
inability to resume their employment. One of the Iraqi
former detainees explained that although he used to be
a “very ambitious man,” his loss of interest in things
he used to enjoy has significantly impaired both his
ability and motivation to resume work. One former Iraqi
detainee recounted having lost his business. Similarly,
another Iraqi individual lost his business and currently
supports his wife and eight children with savings and
rental income from real estate. Another Iraqi individual

described himself as “a housewife” because of his
inability to support himself.

Relocation
Seven individuals reported having relocated after their
release. Two others stated that they have attempted to
or wished that they had the means to relocate because
of the stigma and the insecurities they have faced since
their detention. One individual stated that he believed that
his family is afraid to be with him and would like to take
them out of Iraq but does not have sufficient resources
to do so. Another reported having tried to relocate to a
rural area of Iraq, away from his hometown, but was
unable to do so. One participant stated that he moved
“because my home reminds me of what happened.”
Similarly, one individual stated that he feared re-arrest
and left Iraq to avoid frequent painful reminders of his
incarceration, while another stated that his incarceration
experiences have made him feel very “uncomfortable” in
his home region. This individual left Iraq in order to avoid
the frequent reminders of his imprisonment. Another
individual left his home and moved to another city to
avoid discussing his experiences with his friends and
family. Yet another Iraqi has relocated to a neighboring
country for much of the past two years. He reported that
his life is difficult because he does not have permanent
residency in this country and therefore must leave every
few months to re-validate his visa.

Safety and Security
Many of the men evaluated by PHR were concerned
about their safety and security. One Iraqi former
detainee disclosed that five months prior to his evaluation (in summer of 2006) he had been “taken away” by
the Iraqi secret police and detained for eighteen days.
He described fearing for his life because of this recent
experience and reported an acute level of fear of being
re-arrested. Another former detainee stated that he
feels uncomfortable whenever he sees policemen or
Americans. Similarly, another Iraqi former detainee
described a high level of stress caused by the bombings,
nightly raids, uncertainty about his personal safety, the
frequent funerals of neighbors and acquaintances due
to the war, and ongoing sadness about the losses that
his family had sustained. Nevertheless, he emphasized
that the stressors of his experience in US detention are
the primary reasons for his emotional “disturbances,”
stating, “No sorrow can be compared to my torture experience in jail. That is the top reason for my sadness. I
cannot forget it.”

S hort - T erm and L asting H arm from T orture and I ll - T reatment   9 3

9 4   B roken L aws , B roken L ives

VI. Legal Analysis

Legal Prohibitions Against Torture
and Ill-Treatment
Many of the practices described in this report are torture
under the law.
In the wake of the unspeakable atrocities wrought by
the Second World War, the member states of the United
Nations established universal standards to protect human
dignity.74 To prevent further tragedies like the Holocaust,
states agreed that certain rights were so fundamental
that they could never be abrogated. Among those inalienable rights is the right to be free from torture and cruel,
inhuman or degrading treatment or punishment.75
The international agreements promulgated include
the International Covenant on Civil and Political Rights
(ICCPR) (prohibiting cruel, inhuman or degrading
punishment),76 the Geneva Conventions (including provisions governing prisoners of war and Common Article
3, which prohibits torture and “outrages on personal
dignity”), 77 and the UN Convention Against Torture
(prohibiting both torture and cruel, inhuman or degrading
treatment in all circumstances).78 These treaties, to
Universal Declaration of Human Rights, G.A. Res. 217A, at 71, U.N.
GAOR, 3d Sess., 1st plen. mtg., U.N. Doc A/810 (1948). The Preamble
recognizes “the inherent dignity… of all members of the human
family.” Id. pmbl.

74  

75 

Id. art. 5.
International Covenant on Civil and Political Rights, Dec. 16, 1966,
art. 7, 999 U.N.T.S. 171, entered into force Mar. 23, 1976 [hereinafter
ICCPR].

76  

The Convention for the Amelioration of the Condition of the Wounded
and Sick in Armed Forces in the Field, incl. Annex 1, Aug. 12, 1949,
6 U.S.T. 3114, 75 U.N.T.S. 31; the Convention for the Amelioration of
the Condition of the Wounded, Sick, and Shipwrecked Members of
the Armed Forces at Sea, Aug. 12, 1949, 6 U.S.T. 3217, 75 U.N.T.S.
85; the Convention Relative to the Treatment of Prisoners of War,
incl. Annexes I-V, Aug. 12, 1949, 6 U.S.T. 3316, 75 U.N.T.S. 135 [hereinafter Third Geneva Convention]; and the Convention Relative to
the Protection of Civilian Persons in Time of War, Aug. 12, 1949, 6
U.S.T. 3516, 75 U.N.T.S. 287 [hereinafter Fourth Geneva Convention].
Article 3 in each of the conventions (“Common Article 3”) prohibits
“violence to life and person, in particular murder of all kinds, mutilation, cruel treatment and torture” and “outrages upon personal
dignity, in particular humiliating and degrading treatment.” E.g.,
Third Geneva Convention, supra, art. 3.

77  

UN Convention Against Torture, supra note 1. The United States rati-

78  

which the United States is a party, absolutely prohibit
the use of torture and other cruel, inhuman or degrading
treatment.79
Further, this prohibition has also long been a part of
customary international law and has risen to the level of
jus cogens, such that it is now a “higher law” that cannot
be violated by any State.80 All countries are bound by the
international instruments to which they are a party as
well as jus cogens norms. Any prohibition against torture
or cruel, inhuman or degrading treatment must be interfied the UN Convention Against Torture and the ICCPR subject to the
reservation that “cruel, inhuman or degrading treatment” in Article
16 of the CAT and Article 7 of the ICCPR be interpreted in accordance with the “cruel and unusual punishment” prohibited under the
Fifth, Eighth, and Fourteenth Amendments to the US Constitution.
US Senate Resolution of Advice and Consent to Ratification of the
Convention Against Torture and Other Cruel, Inhumane or Degrading
Treatment or Punishment, 13 Cong. Rec. S17486 (1990).
See, e.g., ICCPR, supra note 76, art. 4, ¶ 2 (prohibiting derogation from
the obligations under Article 7); UN Convention Against Torture, supra
note 1, art. 2 (“No exceptional circumstances whatsoever, whether
a state of war or a threat of war, internal political instability or any
other public emergency, may be invoked as a justification of torture.”)
The UN Committee against Torture has explicitly considered and
rejected the notion that torture can be justified in the context of
anti-terrorism efforts. See Consideration of Reports Submitted by
States Parties under Article 19 of the Convention, Initial Report of the
Republic of Korea, Summary Record of the First Part (Public) of the
267th Meeting, 17th Sess., Dec. 12, 1996, Comm. against Torture, ¶
23.C, U.N. Doc. CAT/C/SR.267, available at www.unhchr.ch/tbs/doc.
nsf/0/4b3833d4b2926c45c1256418002f5e7e?Opendocument (“The
Committee is aware of the security problems and the tense situation
on the Korean peninsula. The Committee has tried to take this fact
into consideration in formulating its conclusions and recommendations. However, it must be emphasized that no exceptional circumstances can ever provide a justification for failure to comply with the
terms of the Convention.”); Concluding Observations of the Committee
against Torture: Israel, Sept. 5, 1997, Comm. against Torture, ¶ 258,
U.N. Doc. A/52/44, available at www.unhchr.ch/tbs/doc.nsf/0/69b6
685c93d9f25180256498005063da?Opendocument [hereinafter UN
Israel Report]; Activities of the Committee against Torture Pursuant to
Article 20 of the Convention against Torture and other Cruel, Inhuman
or Degrading Treatment or Punishment: Egypt, Mar. 5, 1996, Comm.
against Torture, U.N. Doc. A/51/44, available at www.unhchr.ch/tbs/
doc.nsf/(Symbol)/beaf1e1493d8c8cb8025659300389b53?Opendoc
ument.

79  

Filartiga v. Pena-Irala, 630 F.2d 876, 884 (2d Cir. 1980), remanded
to 577 F.Supp. 860 (E.D.N.Y. 1984). The court famously noted, “[T]
he torturer has become like the pirate and slave trader before him
hostis humani generis, an enemy of all mankind.” Id. at 890.

80  

  95

preted in light of the overarching spirit of the conventions
and customary state practice, namely respect for human
dignity.81
Numerous international and regional instruments also
codify the absolute prohibition against torture and cruel
treatment: the American Convention of Human Rights;82
the Inter-American Convention to Prevent and Punish
Torture;83 the European Convention for the Protection
of Human Rights and Fundamental Freedoms; 84 the
European Convention for the Prevention of Torture and
Inhuman or Degrading Treatment or Punishment;85 the
African Charter on Human and People’s Rights;86 the
Arab Charter on Human Rights;87 and the Rome Statute

81 

Torture is described as:
any act by which severe pain or suffering, whether physical or
mental, is intentionally inflicted on a person for such purposes
as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed
or is suspected of having committed, or intimidating or coercing
him or a third person, or for any reason based on discrimination
of any kind, when such pain or suffering is inflicted by or at the
instigation of or with the consent or acquiescence of a public
official or other person acting in an official capacity. It does
not include pain or suffering arising only from, inherent in or
incidental to lawful sanctions.
UN Convention Against Torture, supra note 1, art. 1.1.
American Convention on Human Rights, Nov. 22, 1969, art. 5, 1144
U.N.T.S. 123 (“No one shall be subjected to torture or to cruel,
inhuman or degrading treatment or punishment.”).

82  

of the International Criminal Court.88 Although these
instruments are not directly binding on the United States,
collectively they are indicative of the core standards of
customary international law that apply to all nations.
The United States has traditionally embraced these
standards, reporting to the UN Committee against
Torture in 2000:
Torture is prohibited by law in the United States. It is
categorically denounced as a matter of policy and as
a tool of state authority…Every act of torture within
the meaning of the Convention is illegal under existing
federal and state law, and any individual who commits
such an act is subject to penal sanctions as specified
in criminal statutes.…Torture cannot be justified by
exceptional circumstances . . . .89
This prohibition against torture is firmly embedded in
US law. The sources of law related to the US prohibition of
torture and cruel, inhuman or degrading treatment include
the War Crimes Act,90 the Military Commissions Act,91
the Torture Convention Implementation Act (hereafter
Torture Act),92 the Detainee Treatment Act,93 the Torture
Victims Protection Act,94 as well as the Fifth, Eighth and
Fourteenth Amendments of the US Constitution.95 The
Torture Act criminalizes acts of torture that take place
outside the United States.96 The War Crimes Act (WCA),
Rome Statute of the International Criminal Court, entered into
force July 1, 2002, art. 7.1(f), 2187 U.N.T.S. 90, UN Doc. A/CONF.
183/9, reprinted in 37 ILM 1002 (1998) (listing torture among the
acts that, “when committed as part of a widespread or systematic
attack directed against any civilian population, with knowledge of
the attack,” constitute a crime against humanity) [hereinafter Rome
Statute].

88  

Inter-American Convention to Prevent and Punish Torture, O.A.S.
Treaty Series No. 67, entered into force Feb. 28, 1987, reprinted in
Basic Documents Pertaining to Human Rights in the Inter-American
System, OEA/Ser.L.V/II.82 doc.6 rev.1 at 83 (1992).

83  

European Convention for the Protection of Human Rights and
Fundamental Freedoms, Nov. 4, 1950, art. 3, 213 U.N.T.S. 221, as
amended by Protocols Nos. 3, 5, 8, and 11, entered into force Sept.
21, 1970, Dec. 20, 1971, Jan. 1, 1990, and Nov. 1, 1998. (“No one shall
be subjected to torture or to inhumane or degrading treatment or
punishment.”).

84  

European Convention for the Prevention of Torture and Inhuman
or Degrading Treatment or Punishment, entered into force Feb. 1,
1989, E.T.S. 126.

Consideration of Reports Submitted by State Parties under Article
19 of the Convention: Report of the United States of America, U.N.
Comm. against Torture, Add., at ¶¶ 6, 100, U.N. Doc. CAT/C/28/
Add.5 (2000), available at http://www1.umn.edu/humanrts/cat/catreports2000.html.

89  

War Crimes Act of 1996, Pub. L. 104-192, § 2(a), 110 Stat. 2104, Aug.
21, 1996 (codified as amended at 18 U.S.C. § 2441) (2007).

90  

85  

African [Banjul] Charter on Human and Peoples’ Rights, adopted
June 27, 1981, art. 5, OAU Doc. CAB/LEG/67/3 rev. 5, 21 I.L.M. 58
(1982), entered into force Oct. 21, 1986 (“All forms of exploitation
and degradation of man particularly slavery, slave trade, torture,
cruel, inhuman or degrading punishment and treatment shall be
prohibited.).

86  

Revised Arab Charter on Human Rights, May 22, 2004, art. 8.1,
reprinted in 12 Int’l H.R. Rep. 893 (2005), entered into force March
15, 2008 (“No one shall be subjected to physical or psychological
torture or to cruel, degrading, humiliating or inhuman treatment.”).
Article 4.2 states that the prohibition on torture is non-derogable.
Id. art. 4.2.

Military Commissions Act of 2006, Pub. L. No. 109-366, 120 Stat.
2600 (amending 18 U.S.C.§ 2441) (2006).

91  

Torture Convention Implementation Act of 1994 (Torture Act), Pub.
L. No. 103-236, 108 Stat. 463 (1994) (codified at 18 U.S.C. § 2340
and 2340A) (2004).

92  

Detainee Treatment Act of 2005, Pub. L. No. 109-148, 119 Stat.
2739 (2005) (to be codified in scattered sections of 10, 28, and 42
U.S.C.).

93  

87  

9 6   B roken L aws , B roken L ives

Torture Victims Protection Act of 1991, Pub. L. No. 102-56, 106 Stat.
73 (1992), codified at 28 U.S.C. § 1350 (2007).

94  

US Const. amend. V, VIII, and XIV.

95  
96 

Torture Act 18 U.S.C. § 2340A(a).

which applies to any circumstance “where the person
committing such war crime or the victim of such war
crime is a member of the Armed Forces of the United
States or a national of the United States,” criminalizes
“torture” and “other cruel or inhuman treatment.”97
In response to claims by the Bush Administration
that certain laws did not apply to all detainees in US
custody, Congress passed the Detainee Treatment Act
(DTA) in 2005. Although the DTA was enacted after the
events described in this report, it reaffirmed the longstanding US prohibition on cruel, inhuman, or degrading
treatment.98 It clearly states that the prohibition applies
extraterritorially, in contrast to the position of the
Bush Administration.99 It also defines cruel, inhuman
or degrading treatment, using the standard set out in
the US reservation to the Convention Against Torture, as
meaning the inhumane treatment or punishment prohibited by the Fifth, Eighth, and Fourteenth Amendments
to the Constitution of the United States.100 The DTA also
requires adherence to the standards for military interrogations set by the Army Field Manual on human intelligence gathering.101
Likewise, the Military Commissions Act of 2006 (MCA),
which was enacted after the Supreme Court rendered
its decision in Hamdan v. Rumsfeld,102 was not in force at
the time the detainees evaluated for this report were in
custody, but reinforced the already-standing legal prohibition on torture. The MCA amended and narrowed the
War Crimes Act to limit the instances in which criminal sanctions could apply to certain “grave breaches”
of Common Article 3 of the Geneva Conventions, but
includes torture and cruel or inhuman treatment as
war crimes.103 “Torture” is defined in the MCA as “an act
specifically intended to inflict severe physical or mental
pain or suffering (other than pain and suffering incidental
to lawful sanctions) upon another person for the purpose
of obtaining information or a confession, punishment,
intimidation, coercion, or any reason based on discrimi-

97 

War Crimes Act § 2(a).

98 

Detainee Treatment Act of 2005 42 U.S.C. § 2000dd.

99 

Id. § 2000dd(b).

100 

Id. § 2000dd(d).
Detainee Treatment Act of 2005, Pub. L. No. 109-163, div. A, title
XIV, § 1402(a), 119 Stat. 2739 § 1002(a) (2005) (codified at 10 U.S.C.
§ 801 note).

nation of any kind.”104 “Cruel or inhuman treatment” is
defined by the MCA as “an act intended to inflict severe
or serious physical or mental pain or suffering including
serious physical abuse, upon another within his custody
or control.”105
Three of these sources of US law are particularly
important in assessing the conduct of US personnel
against the detainees evaluated for this report.
First, the federal criminal statute prohibiting the
commission of torture outside the United States, defines
torture as “an act committed by a person acting under the
color of law specifically intended to inflict severe physical
or mental pain or suffering…upon another person within
his custody or physical control.”106 The statute defines
“severe mental pain or suffering” as prolonged mental
harm caused by or resulting from—
A.	 the intentional infliction or threatened infliction of
severe physical pain or suffering;
B.	the administration or application, or threatened administration or application, of mind-altering substances
or other procedures calculated to disrupt profoundly
the senses or the personality;
C.	 the threat of imminent death; or
D.	the threat that another person will imminently be
subjected to death, severe physical pain or suffering,
or the administration or application of mind-altering
substances or other procedures calculated to disrupt
profoundly the senses or personality.107
Second, the Geneva Conventions, which are international treaties that govern the conduct of war, outlaw the
conduct described here. The Third Geneva Convention,
addressing treatment of prisoners of war, provides
that:
No physical or mental torture, nor any other form
of coercion, may be inflicted on prisoners of war to
secure from them information of any kind whatever.
Prisoners of war who refuse to answer may not be
threatened, insulted, or exposed to any unpleasant or
disadvantageous treatment of any kind.108

104 

Id.

105 

Id.

106 

18 U.S.C. § 2340(1).

101  

102 

18 U.S.C. §2340(2). For an explanation of how the anti-torture statute
applies to acts of psychological torture, see PHR Break Them Down,
supra note 17.

107  

Hamdan v. Rumsfeld, 548 U.S. 557 (2006).
Military Commissions Act of 2006, Pub. L. No. 109-366, 120 Stat.
2600 (amending 18 U.S.C.§ 2441) (2006).

103  

108 

Third Geneva Convention, supra note 77, art. 17.
L egal A nalysis   9 7

Even in circumstances of armed conflict where other
provisions of the Geneva Conventions do not apply, Article
3, common to all the Conventions, (“Common Article 3”)
does apply and prohibits “violence to life and person, in
particular murder of all kinds, mutilation, cruel treatment and torture” and “outrages upon personal dignity,
in particular humiliating and degrading treatment.”109
Under the law as it applied during the period covered by
this report, that is, prior the enactment of the MCA, all
violations of Common Article 3 were deemed war crimes
under the War Crimes Act.
Third, US military law also outlaws torture. The
Uniform Code of Military Justice (UCMJ) is applicable
to US military personnel at all times and in all places
throughout the world. It establishes penalties for acts
of cruelty, oppression or maltreatment.110 The UCMJ
prohibits actions that are intended to degrade or humiliate. Article 128 prohibits assault, which includes the
use of threatening words accompanied by a menacing
act or gesture.111
The meaning of these provisions, moreover, can be
illuminated by reference to decisions interpreting antitorture law by other countries and by international bodies
responsible for interpreting international conventions.

Systematic Torture by the United
States
While the experiences of the detainees evaluated for this
report varied, as chapter 4 shows, consistent patterns
of abuse emerge. Because the participants in the study
were selected in a non-random manner, we cannot
conclude that the abuses they suffered can be generalized to the entire population of detainees in US custody in
Iraq, Afghanistan and Guantánamo Bay, Cuba during the
period covered by the report. The accounts, however, do
add to a growing body of evidence that the United States
has perpetrated systematic torture of detainees as part
of US counterterrorism operations since 9/11.112
Id. art. 3 (imposing obligations on states even “[i]n the case of armed
conflict not of an international character”). This prohibition is found
in all four of the Conventions.

Both the UN Committee Against Torture and cases
decided by international criminal tribunals have addressed
the point at which torture becomes “systematic.” In a
1993 report, the Committee Against Torture reported
to the UN General Assembly that it had established the
following criteria to define “systematic” torture:
The Committee considers that torture is practiced
systematically when it is apparent that the torture
cases reported have not occurred fortuitously in a
particular place or at a particular time, but are seen
to be habitual, widespread and deliberate in at least
a considerable part of the territory of the country in
question. Torture may in fact be of a systematic character without resulting from the direct intention of a
Government. It may be the consequence of factors
which the Government has difficulty in controlling,
and its existence may indicate a discrepancy between
policy as determined by the central Government
and its implementation by the local administration.
Inadequate legislation which in practice allows room
for the use of torture may also add to the systematic
nature of this practice.113
In the context of determining elements of a crime
against humanity, the appeals chamber of the
International Criminal Tribunal for the former Yugoslavia
(ICTY) examined two factors in assessing whether torture
was “systematic”: 1) the “organized nature of the acts,”
and 2) the “improbability of their random occurrence.”114
It stated, “[P]atterns of crimes — that is the non-accidental repetition of similar criminal conduct on a regular
basis — are a common expression of such systematic
occurrence”.115 The ICTY made it clear, however, that it
is not necessary to show that the acts were the result of
the existence of a policy or plan.116
In assessing whether the torture perpetrated by the
United States during the period covered by this report
was systematic it is striking that common patterns
have been shown in a variety of reports and investigations, including how widespread the abuses were and

109 

110 

Uniform Code of Military Justice, 10 U.S.C. §§ 801—946 (2007).

111 

Id. § 928.
See sources cited supra notes 6 and 19. Whether torture is systematic
does not have any bearing on individual culpability for war crimes,
as any act of torture is a grave breach of the Geneva Conventions
and also violates US criminal law. Systematic and widespread use
of torture can have a bearing, however, on whether an individual
can be held criminally liable for crimes against humanity. See, e.g.,
Rome Statute, supra note 88, art. 7.1.

Activities of the Committee against Torture Pursuant to Article
20 of the Convention against Torture and other Cruel, Inhuman
or Degrading Treatment or Punishment: Turkey, Comm. Against
Torture, Nov. 15, 1993, U.N. Doc. A/48/44/Add.1, Official Records of
the General Assembly, 48th Sess., Supp. No. 44, ¶ 39.

113  

112  

9 8   B roken L aws , B roken L ives

Prosecutor v. Kunarac, Case Nos. IT-96-23-A & IT-96-23/1-A, Appeal
Judgment, ¶¶ 94-95 (June 12, 2002), available at http://www.icwc.
de/fileadmin/media/ICTY_Kunarac_ACh.pdf.

114  

115 

Id.

116 

Id.

how many practices were authorized by policies at the
highest levels. The evidence from this report is consistent with and reinforces information gleaned from official
US government reports117 independent investigations by
the media and human rights organizations,118 as well as
documents made public from reviews by the International
Committee of the Red Cross.119 These reports all support
the accounts of the former detainees evaluated for this
report on the pervasive use of certain techniques, such
as long-term isolation, sexual humiliation and sexual
abuse, forced nakedness, temperature extremes, stress
positions, and sleep deprivation. Many became standard
operating procedure.
It is also clear that numerous abuses reported by
the detainees in this study were officially authorized
during at least some of the periods during which the
detainees were in custody. These include isolation, forced
nakedness, use of dogs, sleep deprivation, sexual and
other forms of humiliation, stress positions, threats of
harm to the detainee or family members, temperature
extremes, and sensory overload and deprivation, among
others.120 These authorizations reinforce the conclusion
that torture was systematic. From evidence available
to PHR, some of the forms of torture detainees in this
study experienced, including beatings, use of electric
shock and sexual violence, were not specifically authoE.g., OIG Report, supra note 6 (May 2008 DOJ/OIG report relating interagency dissent over the use of interrogation techniques considered to
be illegal and referrals of complaints about the tactics to the highest
level of the US government); Taguba Report, supra note 6 (reporting
that high-ranking officials had knowledge of abusive behavior at
Abu Ghraib such as having male detainees pose nude while female
guards pointed at their genitals; having female detainees expose
themselves to the guards; having detainees perform indecent acts
with each other; and guards physically assaulting detainees by
beating and dragging them with choker chains); Fay Report, supra
note 18 (reporting on violence and sexual abuse of detainees);
Independent Panel to Review DoD Detention Operations, Final Report of
the Independent Panel to Review DoD Detention Operations (2004), available at http://www.defenselink.mil/news/Aug2004/d20040824finalreport.pdf (abuses were “widespread” and serious in numbers and
effect) [hereinafter Schlesinger Report]; Schmidt Report, supra note
6 (documenting use of dogs, sexual humiliation, sleep deprivation,
isolation, and other practices authorized for use at Guantánamo);
Shelton Young, US Department of Defense, Review of DoD-Directed
Investigations of Detainee Abuse (use of techniques designed to train
US soldiers to withstand torture on detainees at Guantánamo and
elsewhere), available at http://www.dodig.osd.mil/fo/Foia/ERR/06INTEL-10-part%201.pdf.

117  

118 

HRW No Blood, supra note 6; Keller, supra note 6.

119 

ICRC Report, supra note 27, ¶ 43.
For relevant documents containing these authorizations, see supra
note 3. A review of the policies that authorized the use of these
methods can be found at PHR Leave No Marks, supra note 17.

120  

rized by the Department of Defense or its commanders
on the ground. The accounts of the detainees evaluated
suggest, however, that once multiple forms of torture
were allowed at the highest levels of command, direct
perpetrators felt confident in employing other forms of
torture as well.

Applicability of the Law to Acts
Committed by US Personnel Against
Detainees
Before turning to each specific detention and interrogation technique experienced by the individuals examined
in this investigation, it must be recognized that multiple
abusive techniques were usually used in combination
presumably for the intended effect of amplifying physical
and psychological pain. Nevertheless, as is demonstrated
below, according to courts and entities responsible for
interpreting the Convention Against Torture, including the
UN Special Rapporteur on Torture and the UN Committee
Against Torture, each technique, when considered on its
own, constitutes prohibited conduct in the form of torture
or cruel, inhuman or degrading treatment or punishment. The US State Department, which is charged by
Congress to assess the human rights record of other
governments, and in doing so relies on international
human rights treaties including the Convention Against
Torture, in innumerable instances, specifically has identified these practices as torture or cruel, inhuman or
degrading treatment or punishment when carried out
by other nations.

Stress Positions: Forced-Standing, Handcuffing,
and Shackling
All of the former detainees were subjected to stress positions such as suspensions, forced standing and various
awkward poses, often while shackled. Stress positions
such as tying detainees’ hands behind their backs and
pulling their arms backwards, or shackling their hands
or both hands and feet for days at a time have been
prohibited by the Convention Against Torture.121 The
UN Committee against Torture has determined that
restraining detainees in very painful positions is by itself
an act of both torture and cruel, inhuman or degrading
UN Comm. against Torture, Report on Mexico Produced by
the Committee Under Article 20 of the Convention, and Reply
from the Government of Mexico, U.N. Comm. Against Torture,
30th Sess., ¶¶ 143, 165, U.N. Doc. CAT/C/75 (2003), available at
http://193.194.138.190/tbs/doc.nsf/(Symbol)/f2950e0f6a5560f1
c1256d5500535b97?Opendocument [hereinafter UN Report on
Mexico].

121  

L egal A nalysis   9 9

treatment.122 It recently determined that the use of “short
shackling” by US personnel constitutes either torture or
cruel, inhuman or degrading treatment and has recommended that the method be prohibited.123 The US State
Department has repeatedly described stress positions as
a form of torture.124 In a review of US practices, the UN
Special Rapporteur on Torture has condemned the use
of stress positions on detainees by the United States as
violating the Convention Against Torture.125
Leading foreign courts have determined that these
techniques amount to torture or cruel, inhuman, or
degrading treatment, either used alone or in combination. These techniques all unduly infringe the suspect’s
rights to dignity and bodily integrity.126 The Supreme
122 

UN Israel Report, supra note 79, ¶ 257.
UN Committee against Torture, Advance Unedited Version,
Consideration of Reports Submitted by States Parties Under Article 19
of the Convention, Conclusions and recommendations of the Committee
against Torture, 36th Sess., ¶ 24, U.N. Doc. CAT/C/U.S.A/CO/2 (2006)
[hereinafter UN Comm. against Torture Report].

Court of Israel has determined that the “frog crouch”127
and the “Shabach position” amount to torture.128 The
European Court of Human Rights has held that “wallstanding,” when used in combination with four other
coercive detention and interrogation methods, amounted
to cruel, inhuman or degrading treatment.129 Similarly
the Inter-American Court of Human Rights (IACHR)
has determined that needlessly handcuffing a detainee
constitutes torture.130 Moreover, US federal courts have
determined that the use of stress positions, such as
being chained to a cot or a wall, constitutes torture for
purposes of civil liability of foreign perpetrators and
their commanders.131 More generally, the US Supreme
Court has recognized the right of detainees to be free
from unnecessary bodily restraint as a due process right
protected by the Fourteenth Amendment.132 Further, use

123  

The US State Department considers suspending victims from
their feet a form of torture. See, e.g., Bureau of Democracy, Hum.
Rts., & Lab., U.S. Dep’t State, 2005 Country Rep. on Hum. Rts. Prac.:
Egypt (March 8, 2006), available at http://www.state.gov/g/drl/rls/
hrrpt/2005/61687.htm [hereinafter State Dep’t 2005 Hum. Rts. Report
on Egypt]. Stress positions have been enumerated as forms of torture
in State Department reports on Eritrea, Iran, Lebanon, North Korea,
Sri Lanka, and Tunisia. Bureau of Democracy, Hum. Rts., & Lab., U.S.
Dep’t State, 2005 Country Rep. on Hum. Rts. Prac.: Eritrea (March 8,
2006), available at http://www.state.gov/g/drl/rls/hrrpt/2005/61568.
htm; Bureau of Democracy, Hum. Rts., & Lab., U.S. Dep’t State, 2005
Country Rep. on Hum. Rts. Prac.: Iran (March 8, 2006), available at
http://www.state.gov/g/drl/rls/hrrpt/2005/61688.htm [hereinafter
State Dep’t 2005 Hum. Rts. Report on Iran]; Bureau of Democracy, Hum.
Rts., & Lab., U.S. Dep’t State, 2005 Country Rep. on Hum. Rts. Prac.:
Lebanon (March 8, 2006), available at http://www.state.gov/g/drl/rls/
hrrpt/2005/61693.htm [hereinafter State Dep’t 2005 Hum. Rts. Report
on Lebanon); Bureau of Democracy, Hum. Rts., & Lab., U.S. Dep’t State,
2005 Country Rep. on Hum. Rts. Prac.: Democratic People’s Republic of
Korea (March 8, 2006), available at http://www.state.gov/g/drl/rls/
hrrpt/2005/61612.htm [hereinafter State Dep’t 2005 Hum. Rts. Report
on North Korea]; Bureau of Democracy, Hum. Rts., & Lab., U.S. Dep’t
State, 2005 Country Rep. on Hum. Rts. Prac.: Sri Lanka (March 8, 2006),
available at http://www.state.gov/g/drl/rls/hrrpt/2005/61711.htm
[hereinafter State Dep’t 2005 Hum. Rts. Report on Sri Lanka]; Bureau
of Democracy, Hum. Rts., & Lab., U.S. Dep’t State, 2005 Country Rep.
on Hum. Rts. Prac.: Tunisia (March 8, 2006), available at http://www.
state.gov/g/drl/rls/hrrpt/2005/61700.htm [hereinafter State Dep’t
2005 Hum. Rts. Rep. on Tunisia].

124  

Human Rights Questions: Implementation of Human Rights Instruments:
Torture and other Cruel, Inhuman or Degrading Treatment or Punishment
- Note by the Secretary-General, U.N. GAOR, 59th Sess., Agenda Item
107(a), ¶ 17, U.N. Doc. A/59/324 (2004), available at http://daccessods.un.org/access.nsf/Get?Open&DS=A/59/324&Lang=E [hereinafter Torture Note by the Secretary-General]; see also PHR Break Them
Down, supra note 17, at 115.

125  

H.C. 5100/94, Public Committee against Torture in Israel v. Israel,
53(4) P.D. 817, ¶ 27.

126  

1 0 0   B roken L aws , B roken L ives

Id. at ¶ 11. The frog crouch is a technique involving “consecutive,
periodical crouches on the tips of one’s toes, each lasting for five
minute intervals.”

127  

The Shabach position is a technique where:

128  

[A] suspect … has his hands tied behind his back. He is
seated on a small and low chair, whose seat is tilted forward,
towards the ground. One hand is tied behind the suspect,
and placed inside the gap between the chair’s seat and back
support. His second hand is tied behind the chair, against its
back support. The suspect’s head is covered by an opaque
sack, falling down to his shoulders. Powerfully loud music
is played in the room.
Id. at ¶ 10. According to the affidavits submitted in court proceedings, “[S]uspects are detained in this position for a prolonged period
of time, awaiting interrogation at consecutive intervals.” Id.
Ireland v. United Kingdom, 25 Eur. H.R. Rep. (ser. A), ¶ 96 (1978).
The UN Committee Against Torture has since determined that stress
positions alone constitute prohibited conduct. See UN Israel Report,
supra note 79, ¶ 257.

129  

Urrutia v. Guatemala, 2003 Inter-Am. Ct. H.R. (ser. C) No. 103, ¶
94 (Nov. 27, 2003).

130  

See generally Cicippio v. Islamic Republic of Iran, 18 F.Supp.2d 62
(D.C. Cir. 1998) (chaining plaintiff to a wall, shackling him in a painful
position, and not permitting him to stand erect among many other
forms of ill-treatment perpetrated by the Iranian government constitutes torture under the TVPA); Hilao v. Marco, 103 F.3d 789, 790
(9th Cir. 1996) (being chained to a cot for three days, among many
other forms of ill-treatment perpetrated by Filipino military against
plaintiff, constitutes torture under the TVPA).

131  

Youngberg v. Romeo, 457 U.S. 307, 316 (1982) (holding that an individual has a substantive due process right to freedom from bodily
restraint even if they are civilly committed or criminally incarcerated). For lower court decisions applying the standard, see, for
example, Davis v. Rennie, 264 F.3d 86 (1st Cir. 2001) (upholding a
§1983 claim for violation of a right to be free from unreasonable
restraints and from excessive use of force against an involuntarily
committed mental patient, and for the failure to intervene to prevent
a violation of those rights); S.M. v. Feaver, No. 03-80567-Civ, 2004
WL 213198, at *3 (S.D. Fla. Jan. 22, 2004) (denying a motion to
dismiss a §1983 claim based on plaintiff’s allegation that she was

132  

of stress positions amounts to torture under the Torture
Act and are war crimes under the War Crimes Act.133
Based on the analysis above, the use of stress positions by US personnel upon the former detainees in this
investigation constituted torture under US and international law.

Prolonged Isolation
All of the former detainees evaluated by PHR as part of
this investigation reported having been put in prolonged
isolation. Isolation, also referred to as “solitary confinement” and “separation,” is a method whereby a detainee
is removed from other prisoners and has contact with
only guards or interrogators. The negative psychological impacts of extended solitary confinement, a form of
sensory deprivation, have been well documented, and an
international legal consensus has emerged to prohibit
prolonged solitary confinement, even when it is applied
for administrative and security reasons.134 International
jurisprudence supports the conclusion that prolonged
isolation can lead to severe or serious prolonged mental
pain and suffering. In interrogation, this technique is
used to disrupt profoundly the senses or personality, and,
therefore, could be prosecuted as an act of psychological
torture. In its human rights country reports on Jordan,
the US State Department has repeatedly criticized the
Jordanian government’s practice of using prolonged
isolation as constituting torture.135
The UN Committee against Torture has encouraged
states to abolish the practice, noting that, outside the
interrogation context, solitary confinement “should be
applied only in exceptional cases and not for prolonged
periods of time”136 and has determined that prolonged

solitary confinement could constitute cruel, inhuman
or degrading treatment or punishment.137 Furthermore,
according to the UN Special Rapporteur on Torture, solitary confinement may impact the psychological “integrity
of the prisoner.”138
The Inter-American Court of Human Rights has
already documented and formally recognized that the
practice is “cruel and inhuman treatment which harms
the psychological and moral integrity of the person,”139
and that incommunicado detention places the detainee
“in a particularly vulnerable position, and increases the
risk of aggression and arbitrary acts in prisons.”140 The
Court has also noted that the combination of isolation
and fear for life can lead to “extreme psychological and
moral suffering” and amounts to prohibited conduct.141
Although the US Supreme Court has held that solitary
confinement under some circumstances may be justified for certain administrative and security reasons,142
US courts have found in a number of cases that solitary
confinement violates the Eighth Amendment when used
for extensive duration.143 The use of solitary confinement
Denmark, U.N. Comm. against Torture, 32nd Sess., ¶ 5.6,
U.N. Doc. CAT/C/32/D/202/2002 (2004), available at U.N. Doc.
CAT/C/32/D/202/2002.
Consideration of Reports Submitted by States Parties under Article 19 of
the Convention: Conclusions and Recommendations of the Committee
against Torture: New Zealand, U.N. Comm. against Torture, 32nd
Sess., ¶ 5(d), U.N. Doc. CAT/C/CR/32/4 (2004).

137  

138 

Torture Note by the Secretary-General, supra note 126, ¶ 46.
Velasquez Rodriguez Case, 1988 Inter-Am. Ct. H.R. (ser. C). No. 4,
¶187 (July 29, 1988).

139  

Suárez Rosero Case, 1998 Inter-Am. Ct. H.R. (ser. C) No. 35, ¶¶
90-91 (Nov. 12, 1997).

140  

Villagran Morales et al. Case (the “Street Children” Case), 1999
Inter-Am. Ct. H.R. (ser. C) No. 63, ¶¶ 163, 167 (Nov. 19, 1999).

141  

subjected to “the use of undue physical (four-point restraints) and
chemical (psychotropic) restraints” while involuntarily committed);
but see Fuentes v. Wagner, 206 F.3d 335 (3d Cir. 2000), cert. denied,
531 U.S. 821 (2002) (putting pre-trial detainee in restraining chair
for eight hours while releasing the detainee every two hours for a
ten-minute period of stretching, exercise, use of toilet, and meal,
when faced with detainee’s disruptive and violent behavior, did not
violate detainee’s substantive due process rights).
133 

See PHR Leave No Marks, supra note 17.

134 

See PHR Break Them Down, supra note 17, at 15.
See e.g., Bureau of Democracy, Hum. Rts., & Lab., U.S. Dep’t State,	
2005 Country Rep. on Hum. Rts. Prac.: Jordan (March 8, 2006), available
at http://www.state.gov/g/drl/rls/hrrpt/2005/61691.htm; Bureau of
Democracy, Hum. Rts., & Lab., U.S. Dep’t State, 2006 Country Rep. on
Hum. Rts. Prac.: Jordan (March 6, 2007), available at http://www.state.
gov/g/drl/rls/hrrpt/2006/78855.htm.

135  

Decisions of the Committee Against Torture Under Article 22
of the Convention against Torture and Other Cruel, Inhuman or
Degrading Treatment or Punishment, Communication No. 202/2002:

136  

Sandin v. Conner, 515 U.S. 472 (1995) (holding that convicted prisoner’s segregation in solitary confinement for thirty days did not
implicate liberty interest under procedural due process analysis but
reserved plaintiff’s right to assert Eighth Amendment claim).

142  

143 

See Hutto v. Finney, 437 U.S. 678, 686 (1978) (upholding thirty-day
limit on solitary confinement set by district court, concluding that
“the length of confinement cannot be ignored in deciding whether the
confinement meets constitutional standards”); Tillery v. Owens, 907
F.2d 418, 426 (3d Cir. 1990) (“The denial of medical care, prolonged
isolation in dehumanizing conditions, exposure to pervasive risk of
physical assault, severe overcrowding, and unsanitary conditions
have all been found to be cruel and unusual under contemporary
standards of decency.”) (emphasis added); Maxwell v. Mason, 668
F.2d 361, 363 (8th Cir. 1981) (“[P]laintiff’s confinement as a punitive measure, in isolation, without adequate clothing or bedding
fully supports [the] conclusion that an Eighth Amendment violation
was established…”). But see Sostre v. McGinnis, 442 F.2d 178 (2d
Cir. 1971), overruled on other grounds by Procunier v. Martinez, 416
U.S. 396 (1974) (holding that segregated confinement for twelve
L egal A nalysis   1 0 1

has led one US federal court of appeals to call into question the legitimacy of information gleaned from interrogations.144 Prolonged isolation as used on the detainees
here constitutes torture under the US Torture Act and
the War Crimes Act.145
Based on the above analysis, the use by US personnel
of prolonged isolation as a technique of interrogation
and a condition of detention with respect to the former
detainees in this investigation was a violation of US and
international law.

Hooding /Blindfolding
All individuals evaluated were hooded or blindfolded for
long periods of time. Hooding, blindfolding, or otherwise
depriving a detainee of sight — like prolonged isolation,
is a form of sensory deprivation and is prohibited under
international law. The UN Committee against Torture
has determined that “hooding under special conditions”
constitutes both torture and cruel, inhuman or degrading
treatment or punishment.146 It noted that this finding
would be “particularly evident” when hooding is used
in combination with other coercive interrogation methods.147 The Committee against Torture has subsequently
reaffirmed that blindfolding constitutes torture.148 The
UN Special Rapporteur on Torture has determined that
“blindfolding and hooding should be forbidden.”149
The European Committee for the Prevention of Torture
months and eight days where prisoner was provided a diet of 2,800
to 3,300 calories a day, adequate personal hygiene, the opportunity
for exercise and for participation in group therapy, reading matter,
and the constant possibility of communication with other segregated
prisoners, until prisoner agreed to abide by prison rules, did not
violate Eighth Amendment).
See Stidham v. Swenson, 506 F.2d 478, 481 (8th Cir. 1974) (finding
that defendant’s confession was coerced and stating, “The record
would indicate that Stidham was not a model prisoner, and there is
substantial testimony in the record indicating that he participated
in the brutal killings; but these facts do not excuse the use of an
extorted confession. We remain a government of laws, and those
charged with law enforcement have a special responsibility to see
that the guilty as well as the innocent are given the protection of the
Constitution. If we depart from this principle, we deal the administration of justice a heavy blow.”).

144  

and Inhuman or Degrading Treatment or Punishment
has noted that blindfolding “will frequently amount
to psychological ill-treatment,” and that the practice
should be abolished.150 The US Department of State has
described blindfolding as a form of torture.151
The European Court of Human Rights held that blindfolding a prisoner constitutes cruel or inhuman treatment
when it is used in combination with other interrogation
or detention methods152 and can constitute torture when
used with other techniques. 153
To the extent that hooding and blindfolding are used
for prolonged sensory deprivation, they constitute torture
under the US Torture Act and are war crimes under the
War Crimes Act.154 The new Army Field Manual on human
intelligence collection also prohibits the use of sensory
deprivation and techniques such as placing of hoods or
sacks over the heads of detainees or using duct tape
over the eyes.155
As per the above discussion, the hooding and blindfolding of the former detainees in this investigation by US
personnel was a violation of US and international law.

Sensory Bombardment
Seven of the former detainees in this investigation
reported being subjected to sound and light bombardment. Sound and light bombardment is used to disorient,
cause anxiety, and even contribute to personality disintegration, as well as to deprive the person of sleep. It is
often combined with other tactics. The UN Committee
against Torture has determined that “sounding of loud
music for prolonged periods” constitutes torture and
cruel, inhuman or degrading treatment or punishment
both when it is used in combination with other methods
of interrogation and when it is used by itself.156 The UN
Special Rapporteur on Torture has similarly determined
that depriving a detainee of, or exposing him to, light for a

Report to the Turkish Government on the visit to Turkey carried out by
the European Committee for the Prevention of Torture and Inhuman
or Degrading Treatment or Punishment (CPT) from 2 to 14 September
2001, ¶¶ 30-31, available at http://www.cpt.coe.int/documents/
tur/2002-08-inf-eng.htm.

150  

145 

See PHR Leave No Marks, supra note 17.

151 

146 

UN Israel Report, supra note 79, ¶ 257.

152  

147 

Id.

148 

UN Report on Mexico, supra note 121.
Civil and Political Rights, Including the Question of: Torture and Detention,
Report of the Special Rapporteur, Sir Nigel Rodley, Submitted Pursuant
to Commission on Human Rights Resolution 2001/62, U.N. ESCOR, 58th
Sess., Annex 1, Agenda Item 11(a), ¶ (f), U.N. Doc. E/CN.4/2002/76
(2001); see also, PHR Break Them Down, supra note 17, at 115.

Ireland v. United Kingdom, 25 Eur. H.R. Rep. (ser. A) (1978); Ocalan
v. Turkey, 37 Eur. Ct. H.R. 238, ¶ 222 (2003).
Aksoy v. Turkey, 1996-VI Eur. Ct. H.R. 2260 (1996); Aydin v. Turkey,
1997-VI Eur. H.R. Rep. 1866 (1997).

153  

149  

1 0 2   B roken L aws , B roken L ives

E.g., State Dep’t 2005 Hum. Rts. Report on Egypt, supra note 124.

154 

See PHR Leave No Marks, supra note 17, at 33.

155 

Army Field Manual 2-22.3, supra note 101.

156 

UN Israel Report, supra note 79, ¶ 257.

prolonged period constitutes torture and ill-treatment.157
The use of both light bombardment and prolonged loud
noise by other countries has been severely criticized by
the US State Department in its human rights Country
Reports. It voiced concern over the use of light bombardment in Senegal: “Police also reportedly forced detainees
to sleep on the floor without any bedding, directed brightlights at their pupils, and beat them with batons.”158 In a
Country Report on Cuba, the State Department focused
on the plight of one individual subjected to loud music
and light bombardment.159
The UN decisions and US State Department concerns
are consistent with international jurisprudence prohibiting the use of sound bombardment. The European Court
of Human Rights determined that the use of loud, continuous noise constitutes inhuman and degrading treatment
when used in combination with other coercive interrogation techniques.160 The Inter-American Court of Human
Rights found that playing the radio at full volume while
hooding a detainee or otherwise subjecting her to light
manipulation constitutes “mental torture,” as these techniques formed part of an overall effort to “obliterate the
victim’s personality and demoralize her.”161 The Supreme
Court of Israel prohibited the playing of loud music as an
interrogation method, finding that this specific technique
causes “particular pain and suffering.”162
Because these methods severely disrupt the senses
or personality, exposure to extremes of light and sound
constitutes torture under the Torture Act163 and amounts

to war crimes under the War Crimes Act.164 At least one
US federal court has found that treatment that included
keeping detainees under bright lights for twenty-four
hours a day constituted cruel, inhuman and degrading
treatment prohibited by international law. 165 Further,
US federal courts have found that exposure to extreme
noise and light in detention and interrogations violates
the Eighth Amendment.166
In sum, the sensory bombardment of the former
detainees in this investigation by US personnel constituted a violation of US and international law.

Use of Extreme Temperatures
All of the individuals whom PHR evaluated reported being
subjected to temperature extremes. The UN Committee
against Torture has found that exposure to extreme
temperatures, even in the absence of other forms of
abusive interrogation or detention techniques, constitutes both torture and cruel, inhuman and degrading
treatment. 167 The UN Committee against Torture
re-affirmed this position in finding that placing a naked
inmate in a freezing, air-conditioned room for extended
periods constitutes torture and is prohibited.168 The UN
Special Rapporteur on Torture has similarly determined
that depriving detainees of clothing and exposing them
to extremes of heat or cold constitutes torture and illtreatment.169 These findings are consistent with other
international decisions prohibiting exposure to extreme
164 

Torture Note by the Secretary-General, supra note 125, ¶ 17
(describing “depriving them of sleep and light for prolonged periods,
exposing them to extremes of heat, cold, noise and light, hooding”
as torture).

157  

Jama v. INS, 22 F.Supp.2d 353, 358 (D. N.J. 1998) ����������������
(finding actionable claim for cruel, inhuman and degrading treatment under the
Alien Tort Claims Act where detainees were kept under bright lights
twenty-four hours a day and not permitted to sleep and where other
ill-treatment including being forced to live in filth and constant smell
of human waste, packed in rooms with twenty to forty detainees,
beaten, deprived of privacy, subjected to degrading comments from
guards and sexual abuse).

Bureau of Democracy, Hum. Rts., & Lab., U.S. Dep’t State, 2005 Country
Rep. on Hum. Rts. Prac.: Senegal (March 8, 2006), available at http://
www.state.gov/g/drl/rls/hrrpt/2005/61589.htm.

158  

Bureau of Democracy, Hum. Rts., & Lab., U.S. Dep’t State, 2005 Country
Rep. on Hum. Rts. Prac.: Cuba (March 8, 2006), available at http://www.
state.gov/g/drl/rls/hrrpt/2005/61723.htm (“Throughout March and
April, authorities subjected political prisoner Jose Daniel Ferrer
Garcia to deafeningly loud music and noise from a speaker placed
by the guards at the entrance to his cell from the early morning
until late each night; as of April 28, he had been denied exposure
to sunlight for seven months.”).

159  

160 

See Lucien v. Peters, 107 F.3d 873 (7th Cir. 1997) (“Allegations of
excessive noise can support the objective element of an Eighth
Amendment claim.”); Kost v. Kozakiewicz, 1 F.3d 176, 180 (3d Cir.
1993) (Section 1983 challenge to conditions of confinement, including
allegations of unbearable noise pollution causing inmates to suffer
degenerative hearing, should not have been dismissed on ground
that issues were addressed in context of previous class action
suit); Williams v. Boles, 841 F.2d 181, 183 (7th Cir. 1988) (incessant
noise may cause agony even though it leaves no physical marks);
Toussaint v. McCarthy, 801 F.2d 1080, 1110 (9th Cir. 1986) (affirming
scope of relief granted by district court based on noise level in the
prison, where evidence showed that there was a “constant level of
noise” that adversely affected the inmates’ hearing).

166  

Ireland v. United Kingdom, 25 Eur. H.R. Rep. (ser. A) (1978).
Urrutia v. Guatemala, 2003 Inter-Am. Ct. H.R. (ser. C) No. 103, ¶¶
58.6, 94 (Nov. 27, 2003).

161 ��

H.C. 5100/94, Public Committee against Torture in Israel v. Israel,
53(4) P.D. 817, ¶¶ 10, 28, 29, 30.

162  

Under the Torture Act, acts that cause prolonged mental harm
include procedures “calculated to disrupt profoundly the senses
or personality.” 18 U.S.C. § 2340(2)(D) (2004).

163  

See PHR Leave No Marks, supra note 17, at 25.

165 ��

UN Israel Report, supra note 79, ¶ 257.

167  
168 

UN Report on Mexico, supra note 121, ¶ 165.

169 

Torture Note by the Secretary-General, supra note 125, ¶ 17.
L egal A nalysis   1 0 3

temperatures,170 as well as the US Department of State’s
own conclusion that exposure to temperature extremes
constitutes torture.171
US federal courts have recognized exposure to
extreme heat and cold as a form of torture when used
in other countries, and have held that abuse involving
such treatment creates a valid civil claim for damages
under the Torture Victims Protection Act172 and is a
basis for asylum relief for refugees.173 According to the
US Supreme Court, even deliberate indifference, much
less intentional action, to such basic needs of a detainee
violates that detainee’s rights under the Fifth, Eighth,
and Fourteenth Amendments.174 Use of temperature
extremes also constitutes torture under the Torture Act
and is a war crime under the War Crimes Act.175
Based on the analysis above, the use of temperature
extremes by US personnel upon the former detainees in
this investigation constituted a violation of both US and
international law.

Sleep Deprivation
All except two of the participants evaluated by PHR
have reported prolonged sleep deprivation, usually in
combination with other abusive interrogation methods.
Courts and other bodies responsible for interpreting the
UN Convention Against Torture have noted that sleep
deprivation is used primarily to break down the will of
the detainee and is clearly prohibited under international anti-torture law when it is not a mere side effect
of a lengthy interrogation. The UN Committee against
Torture has noted that sleep deprivation used to extract
confessions from suspects is impermissible,176 and that
170 

See, e.g., Tekin v. Turkey, 1998-IV Eur. Ct. H.R. ¶ 54 (1998).
State Dep’t 2005 Hum. Rts. Report on Egypt, supra note 124; Bureau
of Democracy, Hum. Rts., & Lab., U.S. Dep’t State, 2005 Country Rep.
on Hum. Rts. Prac.: Yemen (March 8, 2006), available at http://www.
state.gov/g/drl/rls/hrrpt/2005/61703.htm [hereinafter State Dep’t
2005 Hum. Rts. Report on Yemen].

“sleep deprivation for prolonged periods” constitutes
torture.177
The European Committee for the Prevention of Torture
and Inhuman or Degrading Treatment or Punishment
found that sleep deprivation, prolonged standing, and
threats to harm a detainee and/or his family “are clearly
designed to break a detained person’s will and have no
place in the interrogation process.”178 The US State
Department has equated sleep deprivation with torture
in its reports on Iran and Lebanon and has described this
technique as “a primary form of torture” in Yemen.179 The
UN Special Rapporteur on Torture has opined that sleep
deprivation, “condoned and used to secure information
from suspected terrorists” by the United States, violates
the Convention Against Torture.180 The European Court
of Human Rights (ECHR) found that depriving detainees
of sleep pending their interrogation constitutes inhuman
and degrading treatment when used in combination with
other techniques.181 The Supreme Court of Israel recognized that while some interrogations may be lengthy
in order to obtain urgently needed information, sleep
deprivation, as “an end in itself,” violates the rights and
dignity of the suspect because the purpose of such a
method is “breaking” the detainee.182 The Inter-American
Court of Human Rights has determined that when sleep
deprivation is used “to obliterate the victim’s personality and demoralize her” it constitutes torture.183 US
federal courts have repeatedly found sleep deprivation to
violate both the Eighth and Fourteenth Amendments. The
Supreme Court has held that a confession obtained by
depriving a prisoner of sleep for thirty-six hours violated
the individual’s right to due process.184 Subsequently, US
UN Israel Report, supra note 79; see also UN Report on Mexico, supra
note 121, ¶ 143.

177  

171  

Torture Victims Protection Act of 1991, Pub. L. No. 102-56, 106 Stat.
73 (1992), codified at 28 U.S.C. § 1350 (2007).

Report to the Turkish Government on the visit to Turkey carried out by
the European Committee for the Prevention of Torture and Inhuman
or Degrading Treatment or Punishment (CPT) from 7 to 15 September
2003, ¶ 11 (2004), available at http://www.cpt.coe.int/documents/
tur/2005-18-inf-eng.pdf.

178  

172  

See, e.g., Lhanzom v. Gonzales, 430 F.3d 833, 848 (7th Cir. 2005)
(listing exposure to the cold as form of torture used by the government of China against Tibetans as stated in the US State Department
Report in political asylum case).

State Dep’t 2005 Hum. Rts. Report on Iran, supra note 124; State Dep’t
2005 Hum. Rts. Report on Lebanon, supra note 124; State Dep’t 2005
Hum. Rts. Report on Yemen, supra note 171.

179  

173  

DeShaney v. Winnebago, 489 U.S. 189, 199-200 (1989); Hope v.
Pelzer, 536 U.S. 730, 731 (2002); Martino v. Carey, 563 F.Supp. 984,
999 (D. D.C. 1983).

174  

175 

180 

Torture Note by the Secretary-General, supra note 126, ¶ 17.

181 

Ireland v. United Kingdom, 2 Eur. H.R. Rep. (ser. A) 25 (1978).
H.C. 5100/94, Public Committee against Torture in Israel v. Israel,
53(4) P.D. 817, ¶ 31.

182  

See PHR Leave No Marks, supra note 17, at 16.

183 ��

Concluding Observations of the Committee against Torture: Republic of
Korea, Nov. 13, 1996, Comm. against Torture, ¶ 56, U.N. Doc. A/52/44
[hereinafter UN Korea Report].

184  

176  

1 0 4   B roken L aws , B roken L ives

Urrutia v. Guatemala, 2003 Inter-Am. Ct. H.R. (ser. C) No. 103, ¶
94 (Nov. 27, 2003).
Ashcraft v. Tennessee, 322 U.S. 143, 154 (1944); see also Ashcraft
v. Tennessee, 327 U.S. 274 (1946); see generally United States ex

federal courts have held that sleep deprivation constitutes a violation of the Eighth Amendment’s protection
from cruel and inhuman punishment because sleep is
“considered a basic life necessity.”185 Sleep deprivation is
also a form of mental torture under the Torture Act and
is a war crime under the War Crimes Act.186
As per the analysis above, the use of sleep deprivation
by US personnel upon the former detainees in this investigation constituted torture and inhuman and degrading
treatment under US and international law.

Threats of Harm to Detainees and Their Families
The use of various forms of threats were reported by all
the former detainees evaluated by PHR. Threats against
a detainee or a detainee’s family or friends can lead to
severe or serious prolonged mental suffering, and have
accordingly been prohibited under international law as
either cruel and inhuman treatment or torture. The UN
Human Rights Committee has found that conducting a
mock execution within a prison environment constitutes
cruel and inhuman treatment and breaches a State’s
obligation to respect human dignity.187 The UN Committee
against Torture determined that threats, including but
not limited to death threats, constitute both torture and
cruel, inhuman or degrading treatment.188 In its Report
on Mexico, the UN Committee described death threats
as well as threats of harm to family members as “torture
methods.”189 The use of threats has also been described
as torture by the US Department of State in its Country
Reports for Bangladesh and Iran.190
rel. Wade v. Jackson, 256 F.2d 7 (2d Cir. 1958) (depriving arrestee of
sleep for twenty-two hours contributed to violations of due process
rights).
Merritt v. Hawk, 153 F.Supp.2d 1216, 1228 (D. Colo. 2001); see also
Keenan v. Hall, 83 F.3d 1083, 1091 (9th Cir. 1996) (holding that
constant illumination of plaintiff’s cell caused “grave sleep problems” and could constitute constitutional violation); Hoptowit v.
Spellman, 753 F.2d 779, 783 (8th Cir. 1983) (“Adequate lighting is
one of the fundamental attributes of ‘adequate shelter’ required by
the Eighth Amendment.”); LeMaire v. Maass, 745 F.Supp. 623, 636
(D. Or. 1990) (”There is no legitimate penological justification for
requiring [inmates] to suffer physical and psychological harm by
living in constant illumination. This practice is unconstitutional.”),
vacated on other grounds, 12 F.3d 1444 (9th Cir. 1993).

The international jurisprudence is unanimous in its
determination that threats, including threats to a third
person, are prohibited conduct constituting cruel or
inhuman treatment191 and in some cases part of a regime
of mental torture.192 The utterance of threats has been
found in at least one case before the European Court
of Human Rights to trigger “long-term symptoms of
anxiety and insecurity, diagnosed as post-traumatic
stress disorder and requiring treatment by medication,”
which led the Court to find that the threats themselves
“constituted torture.”193
Under US law, threats of imminent death or severe
physical pain or suffering to the individual or others are
explicitly banned as forms of mental torture that can
lead to long-term harm under the Torture Act and are
war crimes under the War Crimes Act.194 An American
army soldier was convicted under the Uniform Code
of Military Justice for violating regulations of handling
detainees, fined $12,000 and sentenced to forty-five days
in a military prison after carrying out a mock execution
near Ramadi, west of Baghdad, in July 2003. According to
sworn statements, he took a suspect to a remote desert
location and forced him to dig his own grave, interrogated
the man, and then ordered soldiers to pretend to shoot
him.195 Courts have found that credible verbal threats of
the use of deadly force can constitute cruel and unusual
treatment that “shocks the conscience” in violation of
the Fifth and Fourteenth Amendments. For instance,
federal appeals courts have found that pointing a loaded
weapon at a civilian without a legitimate law enforcement
purpose violated the Fourteenth Amendment.196
www.state.gov/g/drl/rls/hrrpt/2005/61705.htm [hereinafter State
Dep’t 2005 Hum. Rts. Report on Bangladesh]; State Dep’t 2005 Hum.
Rts. Report on Iran, supra note 124.

185  

186 

See PHR Leave No Marks, supra note 17, at 24.
Linton v. Jamaica, U.N. Human Rights Comm., 46th Sess.,
Communication No. 255/1987, ¶ 8.5 CCPR/C/46/D/255/1987
(1992).

187  

188 
189

UN Israel Report, supra note 79, ¶ 257.

UN Report on Mexico, supra note 121, ¶¶ 143-44.
Bureau of Democracy, Hum. Rts., & Lab., U.S. Dep’t State, 2005 Country
Rep. on Hum. Rts. Prac.: Bangladesh (March 8, 2006), available at http://

190  

Campbell v. United Kingdom — 4 Eur. Ct. H.R. 293 (ser. A) ¶ 26
(Feb. 25 1982), available at http://www.worldlii.org/eu/cases/
ECHR/1982/1.html.

191  

Urrutia v. Guatemala, Inter-Am. Ct. H.R., (Ser. C) No. 103, ¶¶ 93-94
(2003).

192  

Akkoç v. Turkey. App. nos. 22947/93 and 22948/93, 116-17 (Oct. 10,
2000).

193  

194 

See PHR Leave No Marks, supra note 17, at 21.
Mike Mount, Army: Soldiers Did Mock Executions, CNN, May 19, 2005,
available at http://www.cnn.com/2005/U.S./05/19/detainee.abuse/
index.html.

195  

Hawkins v. Holloway, 316 F.3d 777, 787 (8th Cir. 2003) (holding
that “threatening deadly force a as means of oppressing those
employed in his department” elevated “his conduct to the arbitrary
and conscience shocking behavior prohibited by substantive due
process”); Robinson v. Solano County, 278 F.3d 1007, 1014 (9th Cir.
2002) (discussing in dictum that an officer’s conduct in pointing a

196  

L egal A nalysis   1 0 5

Based on this discussion, threats to the former detainees
in this investigation and their families by US personnel
constituted violations of US and international law.

Instilling Fear Through Use of Military Dogs
The use of dogs to instill fear was reported by more
than half of the participants in this investigation. Dogs
have been used in combination with nakedness, hooding
and other techniques to exploit detainees’ fears and as
a means of degrading them. Both the UN Committee
against Torture and the Special Rapporteur have held
that the use of dogs by US personnel during interrogations constitutes torture or cruel, inhuman or degrading
treatment.197 The US Department of State has included
the threat of dog attacks as a reported method of torture
used against prisoners in Libya.198
The technique likely amounts to a form of mental
torture under the Torture Act because it profoundly
disrupts the senses or personality.199 It has subsequently
been explicitly prohibited as an interrogation method
under the new Army Field Manual in accordance with US
Department of Defense Directive 3115.09, which states,
“[M]ilitary working dogs, contracted dogs, or any other
dog in use by a government agency shall not be used as
part of an interrogation approach nor to harass, intimidate, threaten, or coerce a detainee for interrogation
purposes.” 200
As such, the use of military dogs by US personnel
upon the former detainees in this investigation constituted torture and cruel, inhuman, or degrading treatment
under US and international law.

Electric Shocks, Sexual Assault, and
Physical Assault
All of the former detainees evaluated by PHR reported
being subjected to some form of physical assault.
International jurisprudence condemns all forms of
beatings. The UN Committee against Torture has
held that physical beatings such as “blows to various
parts of the body, including the ears, with fists, police
weapons or truncheons” constitute methods of torture.201
Additionally, the UN Human Rights Committee found that
beatings rendering a person unconscious and requiring
medical attention violate Article 7 of the ICCPR (prohibiting torture, cruel, inhuman or degrading treatment or
punishment) and disregard respect for human dignity.202
The US State Department has determined that beatings
and other varied forms of physical abuse constitute
torture, finding that beatings with hands or fists, sticks,
police batons or metal rods,203 burning with cigarettes,204
applying electric shocks,205 and systematic beatings to
obtain a confession during interrogations all constitute
torture.206
Domestic, foreign, and international courts have all
determined that beatings constitute torture or cruel,
inhuman or degrading treatment or punishment. Both
the European Court of Human Rights and the European
Commission of Human Rights have held that beating is at
minimum, a form of cruel, inhuman or degrading treatment or punishment and likely constitutes torture.207 The
European Court has also determined that use of electric
201 

UN Report on Mexico, supra note 121, ¶ 143.
Linton v. Jamaica, U.N. Human Rights Comm., Communication
No. 255/1987, 46th Sess., ¶ 8.5, U.N. Doc CCPR/C/46/D/255/1987
(1992).

202  

loaded weapon at a civilian without a legitimate law enforcement
basis shocks the conscience); see also Burton v. Livingston, 791 F.2d
97 (8th Cir. 1986) 99, 100-101 (finding that a prisoner had stated a
substantive due process claim when he alleged that a prison guard
drew and pointed a loaded pistol at him and ordered him to run so
that the guard would be justified in shooting him).
UN Comm. against Torture Report, supra note 123, ¶ 24; Torture Note
by the Secretary-General, supra note 126, ¶ 17; see also PHR Break
Them Down, supra note at 115.

197  

Bureau of Democracy, Hum. Rts., & Lab., U.S. Dep’t State, 2005 Country
Rep. on Hum. Rts. Prac.: Libya (March 8, 2006), available at http://www.
state.gov/g/drl/rls/hrrpt/2005/61694.htm [hereinafter State Dep’t
2005 Hum. Rts. Report on Libya].

198  

18 U.S.C. § 2340(2)(B) (2004) (“‘[S]evere mental pain or suffering’
means the prolonged mental harm caused by or resulting from . . .
the administration or application, or threatened administration or
application, of . . . procedures calculated to disrupt profoundly the
senses or the personality . . . .”).

199  

200 

Army Field Manual 2-22.3, supra note 101, ¶ 8-2.

1 0 6   B roken L aws , B roken L ives

State Dep’t 2005 Hum. Rts. Report on Egypt, supra note 124; State Dep’t
2005 Hum. Rts. Report on Tunisia, supra note 124.

203  

204 

State Dep’t 2005 Hum. Rts. Report on Tunisia, supra note 124.
State Dep’t 2005 Hum. Rts. Report on Libya, supra note 198; State Dep’t
2005 Hum. Rts. Report on Egypt, supra note 124; State Dep’t 2005
Hum. Rts. Report on Tunisia, supra note 124; Bureau of Democracy,
Hum. Rts., & Lab., U.S. Dep’t State, 2005 Country Rep. on Hum. Rts.
Prac.: Tajikistan (March 8, 2006), available at www.state.gov/g/drl/
rls/hrrpt/2005/61679.htm [hereinafter State Dep’t 2005 Hum. Rts.
Report on Tajikistan]; Bureau of Democracy, Hum. Rts., & Lab., U.S.
Dep’t State, 2005 Country Rep. on Hum. Rts. Prac.: Argentina (March
8, 2006), available at www.state.gov/g/drl/rls/hrrpt/2005/61713.htm;
State Dep’t 2005 Hum. Rts. Report on Sri Lanka, supra note 124; State
Dep’t 2005 Hum. Rts. Report on Bangladesh, supra note 190.

205  

State Dep’t 2005 Hum. Rts. Report on Tajikistan, supra note 205.

206  

Greek Case, 1969 Y.B. Eur. Conv. on H.R. 12 (Eur. Comm’n H.R.);
Selmouni v. France, 1999-V Eur. Ct. H.R. 149, ¶ 105.

207  

shocks in combination of other techniques constitutes
torture.208 US federal courts have repeatedly cited beatings as a form of torture intended to inflict “severe pain or
suffering,” and therefore found that it violates the Torture
Victims Protection Act.209 Such conduct also violates
the Torture Act and the War Crimes Act.210 Moreover,
beatings of any individual is illegal under the Detainee
Treatment Act, which prohibits conduct that violates the
Fifth, Fourteenth, or Eight Amendments.211
Four former detainees reported being sodomized,
subjected to anal probing, or threatened with rape.
Rape not only is an unspeakable infringement of human
rights, but often leaves deep and lasting psychological
scars. The international human rights, criminal justice,
and humanitarian law communities, including the
International Criminal Court (ICC), the ad hoc international criminal tribunals, regional human rights courts,
and the UN human rights bodies, are uniform in their
designation of rape as a violation of human rights and
a crime. Perhaps most significantly, the International
Criminal Court statute considers rape, including sexual
violence, a war crime and, if used systematically against
a civilian population, a crime against humanity.212 The ICC
statute also establishes that rape is a “grave breach” of
the Geneva Conventions.213 Further, the statutes of both
the International Criminal Tribunal for Rwanda (ICTR)
and the International Criminal Tribunal for the Former
See Mammadov v Azerbaijan, Eur. Ct. H.R. App. No. 34445/04 (2006)
(finding alleged ill-treatment, including infliction of electric shocks,
blows struck on the soles of the feet, blows to the body while person
was handcuffed in suspended position, was sufficiently severe to
amount to torture); see also Ozkan v. Turkey, Eur. Ct. H.R. App. No.
21689/93 (2004).

208  

Tachiona v. Mugabe, 234 F. Supp. 2d 401, 420-423 (S.D.N.Y. 2002)
(awarding $1,000,000 in compensatory and $5,000,000 in punitive
damages under the TVPA for torture that resulted in Plaintiff’s
death and which included beating the soles of Plaintiffs’ feet;
beating Plaintiff with rods, rocks and iron bars; hitting Plaintiff in
the face; and whipping Plaintiff with a fan belt from a car); Cabiri
v. Assasie-Gyimah, 921 F. Supp. 1189, 1191, 1196 (S.D.N.Y. 1996)
(holding in TVPA action that beatings committed during interrogations in combination with the application of electric shocks “violate[]
a fundamental principle of the law of nations: the human right to
be free from torture”).

Yugoslavia (ICTY) include rape as a crime that, if used
systematically against a civilian population, may constitute a crime against humanity.214 The ICTY has noted that
rape by a state agent will almost always be torture as
well.215 Article 2(b) of the ICTY statute identifies “torture
or inhumane treatment” as a grave breach of the Geneva
Conventions.216
The Fourth Geneva Convention considers rape as an
act of torture and a war crime.217 Both the European
Court of Human Rights and the Inter-American Court
of Human Rights have characterized rape as inhumane
treatment, and the Inter-American Court later determined that rape is a form of torture and thus a violation of Article 5.2 of the American Convention on Human
Rights.218219 The European Court of Human Rights also
found that rape can constitute a violation of Article 3 of
the European Convention, which prohibits torture.220 The
court found that “[r]ape of a detainee by an official of the
State must be considered to be an especially grave and
abhorrent form of ill-treatment given the ease with which
the offender can exploit the vulnerability and weakened
resistance of his victim.”221
Incidents of penetration with a foreign object clearly
Christine Strumpen-Darrie, Rape: A Survey of International
Jurisprudence, 7 Hum. Rts. Br. 12 (2000).

214  

Prosecutor v. Delalic, Case No. IT-96-21-T, Judgment (Nov. 16,
1998).

215  

The ICTY stated that rape constitutes torture if it “1) causes severe
pain or suffering, whether mental or physical; 2) which is inflicted
intentionally; 3) for such purposes as obtaining information or a
confession from the victim, or a third person, punishing the victim
for an act he or she or a third person has committed or is suspected
of having committed, intimidating or coercing the victim or a third
person, or for any reason based on discrimination of any kind; and
is 4) committed by, or at the instigation of, or with the consent or
acquiescence of, an official or other person acting in an official
capacity.” Id.

216  

209  

See PHR Leave No Marks, supra note 17, at 14.

210  

217 

Article 5.2 states, “No one shall be subjected to torture or to cruel,
inhuman, or degrading punishment or treatment. All persons
deprived of their liberty shall be treated with respect for the inherent
dignity of the human person.” American Convention on Human
Rights, Nov. 22, 1969, art. 5.2, 1144 U.N.T.S.
Raquel Martin Mejía v. Perú, Case 10.970, Report No. 5/96, Inter-Am.
C.H.R. 157, OEA/ser.L/V/II.91, doc. 7 rev. (1996). The court announced
that rape constituted torture if it was: “1) an intentional act through
which physical and mental pain and suffering is inflicted on a person;
2) committed with a purpose; and 3) committed by a public official or
by a private person acting at the instigation of the former.” Id.

219  

Detainee Treatment Act of 2005, Pub. L. No. 109-148, 119 Stat.
2739 (2005) (to be codified in scattered sections of 10, 28, and 42
U.S.C.).

211  

Rome Statute, supra note 88, at arts. 7(1)(g), 8(2)(b)(xxii) & 8(2)(e)
(vi).

212  

213 

Id. art. 8(2)(b)(xxii).

Fourth Geneva Convention, supra note 77, art. 27.

218  

Aydin v. Turkey, 1997-VI Eur. H.R. Rep. 1866, ¶¶ 80-88 (1997).

220 
221 

Id. ¶ 83.

L egal A nalysis   1 0 7

constitute rape under domestic law such as the War
Crimes Act.222
For the reasons stated above, the beatings, use of
electric shock, and sexual abuse that US personnel
committed upon the former detainees in this investigation constituted torture and cruel, inhuman, or degrading
treatment under US and international law.

Forced Nakedness and Sexual Humiliation
All except one of the former detainees evaluated by PHR
described being subjected to forced nakedness and other
forms of sexual humiliation. Sexually degrading acts
have historically been used in combination with other
methods to break down a detainee. Forced nakedness
and sexual humiliation violate human dignity and can
lead to long-term psychological harm.223 Sexual humiliation and stripping a detainee of his clothes adds to his
sense of vulnerability224 and are “intended to cause . .
. feelings of humiliation and inferiority.”225 The use of
sexually humiliating acts at Abu Ghraib, Guantánamo,
and other US overseas detention facilities exploited the
cultural values of detainees and has left detainees with
deep, prolonged feelings of shame and humiliation.
General George Fay found that keeping detainees in a
state of undress and forcing them to simulate sexual
positions at Abu Ghraib was clearly degrading and humiliating and violated the Uniform Code of Military Justice
and other laws and regulations.226 Partially in response to
the detainee abuse uncovered in Iraq and at Guantánamo,
sexual humiliation is now categorically prohibited by the
new Army Field Manual. 227
222 

Rape is defined in the MCA as:
The act of a person who forcibly or with coercion or threat of
force wrongfully invades, or conspires or attempts to invade,
the body of a person by penetrating, however slightly, the
anal or genital opening of the victim with any part of the body
of the accused, or with any foreign object.
Military Commissions Act of 2006, Pub. L. No. 109-366, 120 Stat.
2600 (amending 18 U.S.C.§ 2441) (2006).

The severe mental pain and suffering of those who
have been subjected to sexually humiliating acts constitute cruel or inhuman treatment and can also be considered a psychological form of torture. The UN Special
Rapporteur on Torture has found that both depriving
detainees of clothing and stripping them naked are
psychologically harmful methods used by the United
States that constitute torture and ill-treatment.228 The
UN Committee against Torture has explicitly called on the
United States to rescind interrogation methods involving
sexual humiliation.229 These findings are consistent with
the US State Department’s own determinations. It has
concluded that stripping individuals of their clothes
constitutes torture or cruel, inhuman or degrading treatment. For example, in its Country Report for Cameroon,
the agency noted: “Security forces continued to subject
prisoners and detainees to degrading treatment,
including stripping...”230 In its Country Report for Egypt,
it determined that, “Principal methods of torture reportedly employed by the police and the [state intelligence
service] included stripping and blindfolding victims…”231
It has similarly reported that in North Korea “methods of
torture reportedly included …prolonged periods of exposure” and “humiliations such as public nakedness”.232
The European Court of Human Rights recognizes
that the feelings of anguish and inferiority that result
from sexual humiliation may continue to persist after
the actual event has passed.233 The European Committee
for the Prevention of Torture and Inhuman or Degrading
Treatment or Punishment has found that even mere
threats of sexual humiliation “could be considered to
amount to psychological torture.”234
In the United States, a federal appeals court has
stated, “[C]lothing is a ‘basic necessity of human existence’ which cannot be deprived in the same manner
228 

Torture Note by the Secretary-General, supra note 126, ¶ 17.

229 

UN Comm. against Torture Report, supra note 123, ¶ 24.

223 

Aydin v. Turkey, 1997-VI Eur. H.R. Rep. 1866, ¶¶ 80-88 (1997).

224 

Id. at ¶ 25.

225 

Iwanczuk v. Poland, No. 25196/94, 38 Eur. H.R. Rep. 8, § 59 (2001).

231  

226 

Fay Report, supra note 18, at 69.

232 

The new Army Field Manual prohibits “forcing an individual to
perform or simulate sexual acts or to pose in a sexual manner;
exposing an individual to outrageously lewd and sexually provocative behavior” under any circumstances; and “forcing the detainee
to be naked, perform sexual acts, or pose in a sexual manner”
in conjunction with intelligence interrogations. Army Field Manual
2-22.3, supra note 101, ¶ 5-20.

227  

1 0 8   B roken L aws , B roken L ives

Bureau of Democracy, Hum. Rts., & Lab., U.S. Dep’t State, 2005 Country
Rep. on Hum. Rts. Prac.: Cameroon (March 8, 2006), available at http://
www.state.gov/g/drl/rls/hrrpt/2005/61558.htm.

230  

State Dep’t 2005 Hum. Rts. Report on Egypt, supra note 124.
State Dep’t 2005 Hum. Rts. Report on North Korea, supra note 124.
Valasinas v. Lithuania, App. No. 44558/98, 2001-VIII Eur. Ct. H.R.
117 (Sect. 3).

233  

Report to the Russian Government on the visit to the Russian Federation
carried out by the European Committee for the Prevention of Torture
and Inhuman or Degrading Treatment or Punishment (CPT) from 2 to
17 December 2001, ¶ 18, Doc. No. CTP/Inf [2003] 30 (2003).

234  

as a privilege an inmate may enjoy.”235 The US Supreme
Court has also recognized that the protection of human
dignity is a primary function of the Eighth and Fourteenth
Amendments.236
The legislative history of the War Crimes Act reinforces
that it is a war crime to force detainees to be naked,
perform sexual acts, or pose in a sexual manner.237 A
July 2007 Executive Order implementing the Military
Commissions Act forbids conditions of detention and practices of interrogation that includes sexual humiliation.238
Based on the analysis above, the use of forced nakedness and sexual humiliation by US personnel upon the
former detainees in this investigation constituted violations of both US and international law.

Other Conditions of Detention
Each of the former detainees evaluated by PHR stated
that they had endured harsh and abusive living conditions
during their time in US custody. In addition to conditions
of detention such as forced nakedness, isolation, sleep
deprivation and others that appear to have been part of
the interrogation strategy — and which amount to torture
and cruel, inhuman or degrading treatment regardless of
the purpose — other circumstances the former detainees
reported include denial of food, inadequate or inappropriate use of lighting, and being held in unsanitary and/or
tiny cells. These conditions amount to cruel, inhuman or
degrading treatment under numerous international treaties to which the United States is a signatory. The jurisprudence of several regional human rights bodies also
Maxwell v. Mason, 668 F.2d 361, 363, 365 (8th Cir. 1981) (holding
that even inmates in solitary confinement have dignitary interest
in being clothed where inmate was kept in his underwear) (citing
Finney v. Arkansas Board of Corrections, 505 F.2d 194, 207-8 (8th
Cir. 1974)).

235  

Trop v. Dulls, 356 U.S. 86, 101 (1958) (plurality opinion) (“The basic
concept underlying the Eighth Amendment is nothing less than
the dignity of man.”); Hope v. Pelzer, 536 U.S. 730 (2002) (emphasizing the humiliation caused by depriving the prisoner of bathroom breaks while he was handcuffed to a hitching post as part of
Eight Amendment violation); Rochin v. California, 342 U.S. 165, 174
(1952) (holding that pumping man’s stomach in search of swallowed
narcotics was means “so brutal and so offensive to human dignity”
that it violated the Fourteenth Amendment).

236  

152 Cong. Rec. S10,390 (daily ed. Sept. 28, 2006) (statement of Sen.
Warner), available at http://frwebgate.access.gpo.gov/cgi-bin/
getpage.cgi?position=all&page=S10390&dbname=2006_record; see
also 152 Cong. Rec. S10,384 (daily ed. Sept. 27, 2006) (statement of
Sen. Levin), available at http://frwebgate.access.gpo.gov/cgi-bin/
getpage.cgi?position=all&page=S10384&dbname=2006_record.

237  

Interpretation of the Geneva Conventions Common Article 3 as
Applied to a Program of Detention and Interrogation Operated by
the Central Intelligence Agency, Exec. Order No. 13,440, § 3(b)(i)(E),
72 Fed. Reg. 40,707 (July 24, 2007).

238  

helps to establish that the conditions reportedly endured
by the former detainees evaluated for this report amount
to violations of international law.
The ICCPR obligates the US government to not subject
persons within its control to torture or cruel, inhuman or
degrading treatment. Conditions of detention including
lack of sanitary conditions and decent food constitute
acts of cruel, inhuman, or degrading treatment under the
ICCPR and the Convention Against Torture.239 In Mukong v.
Cameroon, for example, the UN Human Rights Committee
held that the detention of a prisoner in unsanitary conditions without food or clothing violated the prisoner’s
right to protection against cruel, inhuman or degrading
treatment.240 The conditions complained of in Mukong
were very similar to many of the reports of substandard
treatment made by the former detainees evaluated for
this report.
In addition to violating the international legal norms
discussed above, a number of regional human rights
bodies have deemed conditions of detention similar
to those described in this report as illegal. The InterAmerican Commission on Human Rights, for example,
held that keeping a detainee confined for twenty-three
hours per day in a cell infested with flies and maggots,
deprived of food, adequate lighting and ventilation
constituted cruel, inhumane or degrading treatment.241
Further, the African Commission on Human and People’s
Rights deemed that a prisoner who was chained to a
floor, not allowed to bathe, and fed only twice a day had
endured treatment that amounted to cruel, inhuman
or degrading treatment.242
See, e.g., Henry v. Trinidad and Tobago, Comm. No. 752/1997, U.N.
GAOR Hum. Rts. Comm., 64th Sess., ¶¶ 1.1-2.4, U.N. Doc. CCPR/
C/64/D/752/1997 (1999) (finding that inmate endured cruel, inhuman,
or degrading treatment when confined in cell that was filthy and
infested with roaches, flies, and rats, without natural lighting or
ventilation for up to twenty-four hours at a time); U.N.H.R. Comm.,
Hylton v. Jamaica, Comm. No. 407/1990, U.N. GAOR Hum. Rts.
Comm., 57th Sess., ¶¶ 2.6-2.7, U.N. Doc. CCPR/C/51/D/407/1990
(1994) (finding that inmate endured cruel, inhuman, or degrading
treatment when subjected to at least two weeks of confinement with
only one or two meals a day and sometimes without water, as well
as beatings that resulted in serious physical injuries).

239  

Mukong v. Cameroon, Comm. No. 458/1991, U.N. GAOR Hum. Rts.
Comm., ¶ 9.4, U.N. Doc. CCPR/C/5/51/D/458/1991 (1994).

240  

McKenzie v. Jamaica, Case 12.023, Inter-Am. C.H.R. 918, Report
No. 41/00, ¶¶ 85-90 (1999).

241  

Media Rights Agenda v. Nigeria, Afr. Comm’n on Human and Peoples’
Rts., Comm. No. 224/98, ¶ 40, 2000-2001 Afr. Ann. Act. Rep., Annex
V.; see also Huri-Laws v. Nigeria, African Comm’n on Human and
Peoples’ Rts., Comm. No. 225/98, 14th Ann. Activity Report of the
Afr. Comm’n on Human and Peoples’ Rts., Annex V, ¶¶ 5-9 (2000)
(holding that pre-trial detainee confined for approximately two

242  

L egal A nalysis   1 0 9

Based on the above discussion, many of the conditions
of detention to which US personnel subjected the former
detainees in this investigation constituted violations of
US and international law.

Reparations and Justice for Victims of
Torture
Reparations by the US government for the unlawful
arrest and detention, torture and/or cruel, inhuman
or degrading treatment that these former detainees
endured is a necessary step toward re-establishing the
historic US commitment to the rule of law. Redressing
the damage caused to these individuals should include,
as required by individual circumstances, a variety of reparations, such as clearing the detainee’s name, restoring
social status, citizenship, employment and place of residence, and returning property. Monetary compensation
is warranted for damage resulting from the physical
and mental harm, emotional distress, and loss of earnings, harm to dignity, medical, psychological and social
services as well as legal fees. Further reparations could
include public acknowledgement of the facts, apology,
and acceptance of responsibility and guarantees of
non-repetition.243
In any form it might take, reparation would send a clear
message that torture cannot be perpetrated with impunity. Although reparation alone can never be a substitute
for accountability,244 it is an element of justice for these
former detainees as well as a way of enabling those
who are in precarious living situations as a result of the
abuses they endured to return to normal life. Monetary
compensation, in particular, is needed to ensure recovery
and rehabilitation for the long-term health consequences
caused by being subjected to torture or other cruel,
inhuman or degrading treatment. Both international
and domestic instruments make provision for such
reparations.
International law obliges the United States to provide
compensation for the unlawful arrest and detention of
these individuals, as well as for the torture and/or cruel,
inhuman or degrading treatment to which they have been
weeks during which he was subjected to unsanitary conditions,
denied necessary medical attention, and physically beaten, had
suffered cruel, inhuman or degrading treatment). Communication
225/98, 14th Ann. (2000-2001)
For a comprehensive summary of types of reparation, see Redress,
What is Reparation, at www.redress.org/what_is_reparation.html.

243  

Luc Walleyn, Incorporating Victims’ Views in Reparation Cases: a
Challenge for Lawyers 3, available at www.redress.org/PeacePalace/
IncorporatingVictimsLW.pdf

244  

1 1 0   B roken L aws , B roken L ives

subjected.245 Articles 2(3) and 9(5) of the ICCPR set the
standard for effective compensation under international law.246 Article 9(5) of the ICCPR states, “[A]nyone
who has been the victim of unlawful arrest or detention shall have an enforceable right to compensation.”
Similarly, the right to compensation is protected under
the UN Basic Principles and Guidelines on the Right to a
Remedy and Reparation for Victims of Gross Violations of
International Human Rights Law and Serious Violations
of International Humanitarian Law.247 Further, Article 14
of the Convention against Torture stresses that: “each
State Party shall ensure in its legal system that the victim
of an act of torture obtains redress and has an enforceable right to fair and adequate compensation, including
the means for as full rehabilitation as possible.”248 The
Declaration of Basic Principles of Justice for Victims
of Crimes and Abuse Power is also indicative of the
international norm that torture victims are entitled
to reparations.249
In January 2007 the Canadian government offered
Maher Arar a formal apology and a $10.5 million
(Canadian dollars) compensation package after he was
detained by US officials and sent to Syria where he was
tortured for ten months before being released and sent
back to Canada.250 This and other foreign cases indicate
See Amnesty Int’l, USA: Despite Releases, Guantánamo Remains
an Affront to the Rule of Law, AI Index AMR 51/041/2004, Feb.
27, 2004, available at http://web.amnesty.org/library/index/
engamr510412004.

245  

ICCPR, supra note 76, art. 2(3), 9(5). Article 2(3) states, “Each State
Party to the present Covenant undertakes: (a) To ensure that any
person whose rights or freedoms as herein recognized are violated
shall have an effective remedy, notwithstanding that the violation
has been committed by persons acting in an official capacity; (b) To
ensure that any person claiming such a remedy shall have his right
thereto determined by competent judicial, administrative or legislative authorities, or by any other competent authority provided for
by the legal system of the State, and to develop the possibilities of
judicial remedy; (c) To ensure that the competent authorities shall
enforce such remedies when granted.” Id. art. 2(3).

246  

Basic Principles and Guidelines on the Right to a Remedy and
Reparation for Victims of Gross Violations of International Human
Rights Law and Serious Violations of International Humanitarian
Law, G.A. Res. 60/147, U.N. GAOR 3d Comm., ­­­60th Sess., U.N. Doc.
A/C.3/60/L.24 (Mar. 21, 2006).

247  

248 

UN Convention Against Torture, supra note 1, art. 14.1.
Declaration of Basic Principles of Justice for Victims of Crime and
Abuse of Power, G.A. Res. 40/34, U.N. GAOR, 96th Sess., Supp. No.
53, at 214, ¶¶ 12-13, U.N. Doc. A/RES/40/34 (1985), available at
http://www.unhchr.ch/html/menu3/b/h_comp49.htm.

249  

Harper’s apology “means the world”: Arar, CBC News, Jan. 26, 2007,
available at http://www.cbc.ca/canada/story/2007/01/26/harperapology.html (stating that the US government, in part, had relied
on inaccurate intelligence reporting from the Canadians).

250 

a trend toward accountability and reparation that the
United States must emulate.
Despite leading international efforts such as the UN
Voluntary Fund for Victims of Torture,251 the United States
has declined to apologize, much less pay compensation to any individual in connection with its detention
and interrogation practices in Iraq or Guantánamo Bay.
Indeed, in the case of Maher Arar, it has vigorously fought
all claims for compensation, even to the point of claiming
that national security and foreign policy considerations
prevent the case from being brought at all.252 In the case of
Khaled El-Masri, another individual subjected to extraordinary rendition and torture, the United States successfully
invoked a state secrets defense as a means of blocking
discovery of key evidence in a claim for compensation.253
Claims for compensation for torture committed by US
agents anywhere in the world should be recognized. In
a landmark 1980 decision, Filártiga v. Peña-Irala, a US
appeals court held that the prohibition on torture was so
universally accepted that a US Court could hold responsible a Paraguayan official charged with torturing a dissiSee Daniel Prémont, Voluntary Fund: UN Support to Victims of Torture,
at http://www.un.org/events/torture/fund.htm; UN Voluntary Fund
for Victims of Torture, at http://www.ohchr.org/EN/Issues/Pages/
TortureFundMain.aspx.

251  

252 

dent in Paraguay. The court declared that when officials
violate a fundamental norm such as torture, they can
be held accountable anywhere within the United States
that they are found.254 In the 2004 case Sosa v. AlvarezMachain,255 the US Supreme Court left open the possibility
that federal courts could consider certain violations of
widely accepted international norms under the Alien
Tort Statute.
Aside from these possible legal remedies, which
force victims to seek redress in the courts, the United
States should recognize a moral obligation to provide
compensation. Moreover, if victims do bring civil actions
for redress, the US government should end its current
obstructionist policy of seeking to prevent the courts
from even deciding the merits of the claims by invoking
state secrets, sovereign immunity, or similar defenses.

Conclusion
Many of the techniques reported to have been employed
against the eleven individuals evaluated by PHR, some
over long periods of time and often in combination with
other prohibited techniques, constituted acts of torture or
cruel, inhuman or degrading treatment under domestic
and international law. Some amounted to war crimes.

Arar v. Ashcroft, 414 F. Supp. 2d 250 (E.D.N.Y. 2006).
El Masri v. United States, 479 F.3d 296 (4th Cir. 2007), cert. denied128
S. Ct. 373 (2007), available at http://pacer.ca4.uscourts.gov/opinion.
pdf/061667.P.pdf.

Filartiga v. Pena-Irala, 630 F.2d 876 (2d Cir. 1980), remanded to 577
F.Supp. 860 (E.D.N.Y. 1984).

254  

253  

255 

Sosa v. Alvarez-Machain, 542 U.S. 692 (2004).

L egal A nalysis   1 1 1

1 1 2   B roken L aws , B roken L ives

VII. Conclusion and Recommendations

E

ven though the particular experiences of the
former detainees evaluated by PHR varied during
their time in US custody, and although clear differences existed between the treatment of detainees in Iraq,
Bagram, Kandahar and elsewhere in Afghanistan, and
at Guantánamo Bay, Cuba — such as the routine use
of long-term nakedness, suspensions, and instance
of rape at Abu Ghraib and the routine beatings at the
Afghanistan facilities — significant consistencies were
found among all the accounts. Repeated and combined
use of techniques including beatings, isolation, stress
positions, temperature extremes, sensory overload
and deprivation, sleep deprivation, and other forms of
torture were reported by all former detainees evaluated.
This consistent pattern, especially when considered in
conjunction with the many other reports about detainee
treatment, including those from official investigations by
the US government, the International Committee of the
Red Cross, first-hand accounts, and the media, as well
as government documents, leads to the conclusion that
United States systematically employed torture and illtreatment against detainees during the periods covered
by this report.
The abusive practices reported by the detainees in this
investigation took place in a context of official authorization, legal justification, and tactical standardization
across three operational theatres. Many of the methods
used were officially authorized by civilian and military
authorities during at least some of the periods during which
the detainees were held in US custody. From evidence
available, other abusive practices found in this report, such as
routine beatings, electric shocks, and sexual violence, do
not appear ever to have been authorized, but were nevertheless tolerated within a permissive command environment.
The creation of this environment was neither incidental nor
accidental. Rather, it resulted directly from a radical and
unjustifiable re-interpretation of US and international
law that stripped human rights protections from detainees
in U.S custody. Legal opinions issued by the Department
of Justice and the Department of Defense dehumanized
detainees and encouraged the formulation of policies and

practices that inevitably led to widespread abuse.256
Congress has taken some steps to end many of these
practices and authorizations, although some have been
undermined or subverted by the President. The Detainee
Treatment Act extends the prohibition on cruel, inhuman
or degrading treatment extra-territorially, although a
signing statement by the President assumed authority to
ignore the law; and the Military Commissions Act, while
narrowing the definitions of war crimes under US law,
nevertheless criminalizes all forms of torture and cruel
treatment documented in this report.257
The Defense Department, too, has both repudiated and
prohibited many of the interrogation practices and conditions of detention set out in this report. In September
2006, it issued a new field manual on interrogation258
that requires compliance with the Geneva Conventions
and prohibits the use of torture or cruel, inhuman or
degrading treatment. It explicitly prohibits the following:
forcing a detainee to be naked, perform sexual acts, or
pose in a sexual manner; placing hoods or sacks over
the head of a detainee, using duct tape over the eyes, and
other forms of sensory deprivation; applying beatings,
electric shock, burns, or other forms of physical pain;
“waterboarding;” using military working dogs to harm or
threaten a detainee; inducing hypothermia or heat injury;
conducting mock executions; depriving the detainee of
necessary food, water, or medical care; and threats of
harm to the detainee or his family. It also identified a
“golden rule” standard, under which a technique that
an interrogator would not want used on an American
soldier should not be used “against any detainee regardless of status or characterization.” On the other hand, an
See Bybee Memo, supra note 14; Memorandum from John C. Yoo,
Assistant Attorney General, Office of Legal Counsel, Department of
Justice to William J. Haynes II, General Counsel of the Department of
Defense (March 14, 2003), available at http://media.washingtonpost.
com/wp-srv/nation/pdfs/OLCMemo1-19.pdf?sid=ST2008040102264
and http://media.washingtonpost.com/wp-srv/nation/pdfs/
OLCMemo20-39.pdf. Memorandum from General Ricardo Sanchez
to Combined Joint Task Force Seven and the Commander, 205th
Intelligence Brigade 4 (Sept. 10, 2003), available at http://www.
humanrightsfirst.info/pdf/06124-etn-sep-10-sanchez-memo.pdf.

256  

257 

See PHR Leave No Marks, supra note 17.
Army Field Manual 2-22.3, supra note 101, ¶ 5-20.

258 

  113

appendix in the new field manual continues to permit the
use of isolation for up to thirty days per authorization and
limiting sleep to four hours a night for individuals who
are Unlawful Enemy Combatants and are not designated
as Prisoners of War.
The new interrogation standards, however, only apply
to individuals in Defense Department custody, and the
President vetoed a bill that would have applied the new
field manual to the Central Intelligence Agency (CIA).
Moreover, the Bush Administration has claimed, without
legal basis, that the Military Commissions Act gives the
CIA wide latitude in the use of “enhanced” interrogation
techniques. In an executive order issued in July 2007,259
the President introduced a definition of humiliating and
degrading treatment to mean only “willful and outrageous acts of personal abuse done for the purpose of
humiliating or degrading the individual in a manner so
serious that any reasonable person, considering the
circumstances, would deem the acts to be beyond the
bounds of human decency.” Subsequent testimony and
statements by Bush Administration officials, including
a letter of March 5, 2008, from the Justice Department
to Congress, make it clear that they claim that the standard put forth by this executive order provides them great
leeway in using “enhanced” techniques, even to the point
of using a new test that allows the claimed value of the
information to be weighed against the harm to the individual.260 Under this standard, even waterboarding would
be permissible in some circumstances.
It must be noted that no independent investigation
that includes access to all relevant documents and officials has been conducted of US detainee treatment and
interrogation practices during the period covered by
this report, and no individuals other than a few enlisted
personnel and one officer at Abu Ghraib have been prosecuted for their actions in performing or authorizing
the conduct described here. Furthermore, no effort to
provide compensation of any kind to the individuals who
have suffered grievous harm as a result of the torture
and cruel, inhuman and degrading treatment inflicted
on them has been forthcoming.

Based on the findings of this investigation, the United
States should take the following actions:
1.	 The executive branch must repudiate all forms of
torture and cruel, inhuman or degrading treatment.
It should explicitly and in writing establish a uniform
standard of conduct for all agencies that prohibits any
of its military, intelligence or other officials, including
all forms of contract personnel, from engaging in
torture and cruel, inhuman or degrading treatment,
including but not limited to any of the following interrogation or conditions of confinement methods, either
alone or in combination:
•	 Stress positions
•	 Beatings and other forms of physical assault
•	 Use of extremes of temperature
•	 Waterboarding or any other form of simulated
drowning261
•	 Threats of harm to the detainee, his family, or
friends
•	 Sleep deprivation
•	 Sensory bombardment through the use of
extreme noise and/or light
•	 Violent shaking
•	 Religious, cultural, and sexual humiliation,
including, but not limited to, forced nakedness
•	 Prolonged isolation
•	 Sensory deprivation, including but not limited to
hooding and blindfolding
•	 Use of psychotropic, mind-altering, or other
drugs for the purpose of decreasing resistance
or gaining information
•	 Mock execution
•	 Exploitation of phobias, psychopathology, or
physical vulnerability
•	 Rape and sexual assault

Exec. Order No. 13,440, § 3(b)(i)(E), 72 Fed. Reg. 40,707 (July
24, 2007). These acts include: “sexual or sexually indecent acts
undertaken for the purpose of humiliation, forcing the individual to
perform sexual acts or to pose sexually, threatening the individual
with sexual mutilation, or using the individual as a human shield;
or …acts intended to denigrate the religion, religious practices, or
religious objects of the individual.” Id.

259  

Mark Mazzetti, Letters Give C.I.A. Tactics a Legal Rationale, N.Y. Times,
Ap-r. 27, 2008, available at http://www.nytimes.com/2008/04/27/
washington/27intel.html?_r=1&ref=us&oref=slogin.

260  

1 1 4   B roken L aws , B roken L ives

•	 Electric shocks
•	 Deprivation of basic necessities and sanitary
conditions
Congress should enact into law the prohibitions listed
above and establish criminal liability for their violation.
261 

None of the detainees evaluated experienced waterboarding.

2.	 The executive branch and Congress should establish
an independent commission to fully investigate and
publicly report on the circumstances of detention and
interrogation in Bagram, Kandahar, and elsewhere
in Afghanistan, Iraq, Guantánamo Bay, and other
locations since 2001. This independent commission
should have subpoena power to compel witnesses and
have full access to all classified materials concerning
interrogation techniques and conditions of detention, including medical records and documentation
by behavioral health science consultant personnel,
in order to establish a full public record. The investigation should extend to individuals in the position of
making policy as well as those who carried those policies out, including all healthcare professionals who
were in the position of providing care or supporting
the interrogation of detainees.
3.	 All individuals who played any role in the torture or
ill-treatment of detainees, including those who authorized the use of methods amounting to torture or exercised command authority over them, should be held to
account through criminal and civil processes (such as
disciplinary action). Officials at every level should be
held accountable for crimes they committed or for the
acts of officials subordinate to them. Health professionals, both civilian and uniformed, who engaged in
or facilitated the abuse of detainees and/or failed to
report torture and ill-treatment should be investigated, appropriately sanctioned, and disciplined via
the Department of Defense, other executive branch
agencies, and state licensing boards.

4.	 The government should issue a formal apology to
detainees who were subjected to torture and/or illtreatment as part of US military and intelligence operations since fall 2001 in Afghanistan, Iraq, Guantánamo
Bay, Cuba, and elsewhere.
5.	 The government should establish a fair process for
compensation and victim assistance, including access
to rehabilitation and re-integration services, for individuals subjected to torture or ill-treatment in US
custody.
6.	 All places of detention operated by the United States
should be subject to monitoring by international bodies
that investigate detainee treatment and are capable
of reporting findings to the public and government,
including the UN Special Rapporteur on Torture, the
UN Committee Against Torture, and the International
Committee of the Red Cross. These organizations
tasked by treaties to which the United States is a party
must be granted full access to detainees, their medical
records, and all other pertinent files documenting past
and current treatment of detainees during their incarceration. Furthermore, Congressional and executive
branch oversight of US military and intelligence activities relevant to detainee treatment and interrogation
should be immediately strengthened and improved.
7.	 The US Department of Justice should publicly release
all legal opinions and other memoranda concerning
standards regarding interrogation and detention policy
and practices.

C onclusion and R ecommendations   1 1 5

1 1 6   B roken L aws , B roken L ives

Appendix I: Torture: Psychological and
Medical Consequences
262

T

orture can have devastating health consequences
on an individual’s physical, psychological, and
social well-being. These dimensions of health often
impact one another. For example, musculoskeletal pain
from beatings can result in recurrent, intrusive memories of prior abuse. Depression resulting from trauma
may lead to somatic symptoms including headaches
and stomach aches. Torture can result in individuals
becoming withdrawn and socially isolated. Furthermore,
torture impacts the broader community as well through
promoting a culture of fear and mistrust.

Psychological Trauma: The Common
Denominator
Psychological abuse is inherent in the concept of torture.
Systematic, repetitive infliction of psychological trauma
establishes control over another person. Methods of
psychological control are designed to instill terror,
pain, and helplessness and destroy a detainee’s sense
of autonomy without direct use of physical violence.
Such techniques include the use of sleep deprivation,
sensory bombardment and deprivation, use of temperature extremes, stress positions, solitary confinement,
mock execution, severe humiliation, mind-altering drugs
and threats of violence — as well as the exploitation of
personal and cultural phobias. The ultimate effect of
these techniques is to convince the victim that the perpetrator is omnipotent, that resistance is futile, and that his
life depends on absolute compliance.
Although discussion of torture and other cruel,
inhuman and degrading treatment of detainees can be
divided into psychological and physical techniques, ultimately all techniques that violate human dignity carry a
high risk of psychological damage. Further, the distinction between harsh physical and psychological techniques is artificial as most torture techniques involve

This discussion is drawn from the following sources: PHR Leave No
Marks supra note 15; Istanbul Protocol, supra note 7.
262 

both components.263 For example, the consequences of
sexual torture, even in the absence of physical assault,
are both physical and psychological. Torture is a means
of denying an individual’s humanity. By reducing an individual to a position of extreme helplessness and inducing
a constant state of fear, torture often leads to a deterioration of cognitive, emotional and behavioral functions.264
Many torture survivors suffer from debilitating psychological damage that stems from various combinations of
intense and prolonged fear, shame, humiliation, horror,
guilt, grief, and mental and physical exhaustion.265 Ample
evidence from both uncontrolled and controlled studies266
document that most torture survivors suffer an array
of prolonged and serious psychiatric symptoms such
as depression, anxiety disorders, somatic complaints
such as headaches and back pain, post-traumatic stress
disorder (PTSD), memory and concentration impairment,
sleep disturbance and nightmares, sexual dysfunction,
self-harming behaviors and personality changes.267
Feelings of helplessness, anger, guilt, and fear are
263 

Istanbul Protocol, supra note 7, at 45.

264 

Id.

265 

PHR Break Them Down, supra note 17, at 48 (2005).
Similar to research of victims of organized violence, epidemiological
studies of torture survivors are difficult to conduct and have limitations such as small sample size and lack of control groups.

266  

E.g., Caroline Gorst-Unsworth & Eva Goldenberg, Psychological
Sequelae of Torture and Organized Violence Suffered by Refugees
from Iraq: Trauma-Related Factors Compared with Social Factors in
Exile, 172 brit. J. Psychiatry 90 (1998); Mark Van Ommeren et al.,
Psychiatric Disorders Among Tortured Bhutanese Refugees in Nepal, 58
archives gen. Psychiatry 475 (2001); Joop T.V.M. de Jong et al., Lifetime
Events and Posttraumatic Stress Disorder in 4 Postconflict Settings,
286 JAMA 555 (2001); Derrick Silove, et al., The Impact of Torture on
Post-Traumatic Stress Symptoms in War-Affected Tamil Refugees and
Immigrants, 43 COMPREHENSIVE PSYCHIATRY 49 (2002); Allen Keller
& Joel Gold, Survivors of Torture, in 1 kaplan and sadock’s comprehensive
textbook of psychiatry 2400 (Benjamin J. Sadock & Virginia A. Sadock,
eds., 8th ed. 2005); Peter Mygind Leth & Jytte Banner, Forensic
Medical Examination of Refugees Who Claim to Have Been Tortured,
26 AM. J. Forensic med. & Pathology 125 (2005); Pia A. Moisander &
Erik Edston, Torture and Its Sequel – A Comparison Between Victims
from Six Countries, 137 forensic sci. Int’l 133 (2003).

267 

  117

common psychological reactions to torture and are
often associated with major depression and PTSD.268 The
psychological reactions to torture are undoubtedly very
complex since the torture survivor may experience PTSD
as a result of specific torture experiences; depression
as a result of multiple losses associated with torture;
physical symptoms resulting from the specific forms of
torture; and the “existential dilemma” of surviving in a
world in which torture is a reality. 269

Post-Traumatic Stress Disorder
PTSD is one of the most common long-term consequences of torture. It is estimated that the rates of PTSD
range from 45% to 92% across diverse samples of torture
survivors.270 Of note, the rate of PTSD stemming from
different forms of trauma among the general population
between the ages of eighteen and fifty-four in the United
States is approximately 3.6 percent.271
The symptoms of PTSD fall into three main categories: 1) reliving the experience of the traumatic event; 2)
emotional numbing and detachment; and 3) hypervigilance and chronic arousal. The Diagnostic and Statistical
Manual (DSM-IV) requires a one-month duration of symptoms for a diagnosis of PTSD. PTSD that endures for three
months or more is considered to be chronic.272Torture
survivors may continue to re-experience the trauma in
the form of intrusive memories or flashbacks or recurrent
nightmares. They may exhibit avoidance of any thought,
conversation or activity that arouses recollection of the
trauma. Victims also may exhibit hyperarousal or hypervigilance, which may result in difficulty concentrating,
irritability or outbursts of anger.273
Studies show that more than one third of those who
suffer from PTSD fail to recover even after many years.274
Turner, supra note 267.

268  
269 

Several studies conducted on POWs from World War II
and the Korean War and on Holocaust survivors have
confirmed the chronic nature of PTSD, which sometimes persists forty years after exposure to the severe
trauma.275
PTSD can have a negative impact on the successful
management of other chronic medical diseases and
therefore can impact physical health over the long term.
For example, misdiagnosis or under-treatment of PTSD
has been associated with poor control of diabetes in
Cambodian refugees.276 Survivors of the Holocaust and
concentration camps were observed to die at an earlier
age than expected and demonstrated higher rates of
infectious diseases, cancer, cerebrovascular accidents
and heart problems.277

Major Depression and Self-Harming Behavior
Major depression and PTSD are widely acknowledged as
the most common emotional and psychological forms
of distress in torture survivors.278 Epidemiological findings have disclosed that 56% of refugees subjected to
prolonged traumatization such as torture suffer from both
PTSD and a depressive disorder.279 Further, PTSD patients
with depression report a higher frequency of suicidal
thoughts, whereas patients with PTSD alone manifest
an increased frequency of suicidal attempts.280
Studies have consistently demonstrated that exposure to torture and life-threatening events are associated with suicidal behaviors. The intractable suffering
associated with torture has been found to play a central
role in increased self-destructive and suicidal behavior
among refugees who previously experienced traumatic
events. In a study investigating suicidal behavior among
Brian Engdahl, et al., Post-Traumatic Stress Disorder in a Community
Group of Former Prisoners of War: A Normative Response to Severe
Trauma, 154 Am. J. Psychiatry 1576 (1997); Robert A. Zeiss & Harold
R. Dickman, PTSD 40 Years Later: Incidence and Person-Situation
Correlates in Former POWs, 45 J. Clinical Psychol. 80 (1989); Cynthia
Lindman Port, et al., A Longitudinal and Retrospective Study of PTSD
Among Older Prisoners of War, 158 Am. J. Psychiatry 1474 (2001);
Rachel Yehuda, et al., Impact of Cumulative Lifetime Trauma and
Recent Stress on Current Post-Traumatic Stress Disorder Symptoms
in Holocaust Survivors, 152 Am. J. Psychiatry 1815 (1995).

275  

Id.
Van Ommeren, supra note 267; Moisander, supra note 267; Allen
Keller et al., Traumatic Experiences and Psychological Distress in an
Urban Refugee Population Seeking Treatment Services, 194 J. Nervous
& Mental Disease 188 (2006); Ronald C. Kessler, et al., Prevalence,
Severity, and Comorbidity of 12-month DSM-IV Disorders in the National
Comorbidity Survey Replication, 62 Archives Gen. Psychiatry 617 (2005)
[hereinafter Kessler, Prevalence, Severity, and Comorbidity].

270 

271 

Kessler, Prevalence, Severity, and Comorbidity, supra note 270.

American Psychiatric Association, Diagnostic and Statistical Manual (4th
ed. 2000) (the main diagnostic reference of mental health professionals
in the United States) [hereinafter DSM-IV].

276 

Leo Eitenger & Axel Strom, Mortality and Morbidity After Excessive
Stress, 11 Am. J. Community Psychol. 473 (1983).

272 

Istanbul Protocol, supra note 7, at 44.

273 �

Ronald C. Kessler, et al., Post-Traumatic Stress Disorder in the
National Comorbidity Survey, 52 Archives Gen. Psychiatry 1048 (1995)
[hereinafter Kessler, PTSD].

278 

Mollica, supra note 276.
Marcello Ferrada-Noli, et al., Suicidal Behavior After Severe Trauma,
Part 1: PTSD Diagnoses, Psychiatric Comorbidity, and Assessments of
Suicidal Behavior, 11 J. Traumatic Stress 103 (1998).

279  

274  

1 1 8   B roken L aws , B roken L ives

Richard F. Mollica, Surviving Torture, 351 New Eng. J. Med. 5 (2004).

277  

280 

Id.

refugees previously subjected to diverse forms of torture
(including isolation, water torture, mock execution, and
electric shock), 50% of the sample reported suicidal
behavior.281 A study of former POWs found that 57% of
subjects who had been POWs under Japanese control had
suicidal thoughts following their experiences, and 7% of
the German-held POWs had attempted suicide.282
Strikingly, researchers have found that traumatized
individuals expose themselves to situations reminiscent of their torture experience283 — and that the form
of self-destructive or suicidal behavior parallels the type
of torture they experienced. In a sample of sixty-five refugees who survived torture, those who were subject to
blunt force trauma applied to their head and body were
more likely to jump from a height or in front of a train;
those who experienced water torture were more likely
to attempt drowning; and those who were tortured with
sharp force were more likely to engage in self-inflicted
stabbing or cutting.284

Damaged Self-concept and Foreshortened
Future
Torture survivors may have a damaged self-concept (i.e.,
the individual has a subjective feeling of having been
irreparably damaged and having undergone an irreversible personality change) and a sense of foreshortened
future (e.g., not expecting to have a career, marriage,
children, or a normal life span).285 They may exhibit dissociation, a disruption in the integration of consciousness,
self-perception, memory and actions, depersonalization,
a feeling of being detached from one’s self or body, or
atypical behavior such as impulse control problems or
engagement in high-risk behaviors.286

Psychosis
Although uncommon among survivors of torture,
psychosis is among the most serious psychological
consequences of torture, and may present itself in the
form of delusions (including auditory, visual, tactile and
281 

olfactory), bizarre ideations and behaviors, illusions
or perceptual distortions and paranoia. Other serious
consequences include substance abuse and exacerbations of prior mental illness.287
Other residual effects of torture include experiencing
somatic complaints such as pain, headache or other
physical complaints.288

Physical Consequences of Torture
Physical manifestations of torture may involve all organ
systems. Some effects are typically acute while others
may be chronic. Beatings or being restrained in painful
positions can result in musculoskeletal injuries, fractures
and chronic pain syndromes.289 Dermatologic manifestations include scars from injuries, lacerations, or burns.
Prolonged, tight shackling of extremities can result in
linear scarring.290 Poor dentition, including missing/fractured teeth, may result from beatings, malnutrition, and
inadequate access to appropriate dental care.291
Neurological symptoms and findings include headaches, nerve damage (either central or peripheral),
decreased strength or sensation, auditory and visual
impairment, cognitive deficits and dizziness.292 Sexual
abuse and humiliation can result in chronic dysuria,
genital pain, Peyronies disease, strictures, damage to
ligaments (suspensory ligament), erectile dysfunction
(from damage to nerves and arteries as well as psychological), rectal injuries, and exposure to infectious
diseases such as HIV.293
Empirical evidence has shown that a common physical consequence in torture survivors involves pain in
287 

Id. at 44.

288 

Id.
Istanbul Protocol; Physicians for Human Rights, Examining Asylum
Seekers: A Health Professionals Guide to Medical and Psychological
Evaluations of Torture, (Vincent Iacopino, et al., eds., 2001); Jose
Quiroga & James M. Jaranson, Politically Motivated Torture and Its
Survivors: A Desk Study Review of the Literature, 15 Torture: J. on
Rehabilitation of Torture Victims & Prevention of Torture 1 (2005); Allen
Keller, Caring and Advocating for Victims of Torture, 360 Lancet (Supp.)
s55 (2002).

289 ��

Id.
Thomas W Miller, et al., Traumatic Stress Disorder: Diagnostic and
Clinical Issues in Former Prisoners of War, 30 Comprehensive Psychiatry
139 (1989).

282  

Shakeh Momartin & Mariano Coello, Self-Harming Behaviour and
Dissociation in Complex PTSD: Case Study of a Male Tortured Refugee,
16 Torture 20 (2006).

283  

Ferrada-Noli, supra note 279.

284 �

DSM-IV, supra note 272, at 424-29; Istanbul Protocol, supra note
7, at 45.

285  

286 

Istanbul Protocol, supra note 7, at 45.

Istanbul Protocol, supra note 7; Michael Peel & Vincent Iacopino, The
Medical Documentation of Torture (2002).

290  

291 

Istanbul Protocol, supra note 7.
Alejandro Moreno & Michael Grodin, Torture and Its Neurological
Sequelae, 40 Spinal Cord 213 (2002); Ole Vedel Rasmussen, Medical
Aspects of Torture, 37 Danish Med. Bull. (Supp. 1) 1 (1990); Istanbul
Protocol, supra note 7.

292  

Istanbul Protocol, supra note 7; Marie Norredam, et al., Urologic
Complications of Sexual Trauma Among Male Survivors of Torture, 65
Urology 28 (2005).

293  

A ppendix   1 1 9

multiple sites that is long-lasting. For example, musculoskeletal symptoms are present as both acute and
chronic physical consequences associated with torture.
Frequent pains experienced by the survivors are in the
head, neck, shoulder girdle, and the lower back.294 These
disabilities often remain years after release from detention and limit the survivors’ capacity to do anything other
than light work. These pains have been associated with
beatings and painful stress positions, and confinement
in cramped, damp, and unsanitary conditions.295 The pain
can also be psychosomatic and can be directly due to
psychological torture.
It must be noted that torture is often designed to maximize stress and physical pain without causing serious
physical injury or death. In advocating for various aggressive interrogation procedures, a working group established in the Department of Defense by Secretary Donald
Rumsfeld argued that the removal of prisoners’ clothing
would create “a feeling of helplessness and dependence”
and that slapping a prisoner — “a quick glancing slap
to the fleshy part of the cheek or stomach” — could be
useful “as shock measures.” 296

Physical Evidence of Torture
While torture and ill-treatment can have devastating health
consequences, it is important to recognize that there is
individual variability in physical and psychological findings. Individuals respond to and recover from traumatic
events, including torture, in a variety of ways. In some
cases, physical evidence may not be detectable because
most medical evaluations are conducted after the resolution of acute signs and symptoms of physical injury.
The method of torture, its severity, and the anatomical
location of injury often indicate the likelihood of specific
physical findings. For example, beatings and other physical assaults may result in fractures that produce a loss
of bone integrity due to the effect of a blunt mechanical
force on various vector planes.297 Findings from bone
scans can corroborate the history of trauma described
by the victim. Burns may also produce characteristic
Kristine Amris & Patricia Roche, Pain and Disability Rating in Torture
Survivors: Preliminary Findings (2002) (poster presented at the 10th
World Congress on Pain, San Diego, CA).

294  

Amnesty International, A Glimpse of Hell: Reports on Torture Worldwide
(Duncan Forrest, ed., 1996).

295 

Douglas Jehl, Files Show Rumsfeld Rejected Some Efforts to Toughen
Prison Rules, N.Y. Times, June 23, 2004, available at http://www.
nytimes.com/2004/06/23/politics/23PENT.html?ex=1212292800&e
n=7b9c2e7d547ca113&ei=5070.

296 

Istanbul Protocol, supra note 7, § 193, at 36.

297 

1 2 0   B roken L aws , B roken L ives

scars and deformities. The use of electricity and various
methods of burning may also leave highly characteristic
skin changes. Different forms of body suspension and
stretching of limbs may result in characteristic musculoskeletal and nerve injuries. Other unnatural positions and
forms of restraint may cause severe pain and produce
injuries to ligaments, tendons, nerves and blood vessels.
For example, the potential side effects of “Palestiniantype suspension”298 is chronic nerve damage (brachial
plexus) and shoulder dislocation that can result in degenerative arthritis. Despite severe chronic disability, such
forms of torture can leave few, if any, external marks or
radiological findings.299
Other forms of torture may or may not produce
physical findings but are strongly associated with other
conditions. For example, cortical atrophy, diffuse axonal
damage, lesions and scalp bruises can be expected to be
observed in head trauma victims. Beatings to the head
that may have resulted in loss of consciousness are
particularly important to the clinical diagnosis of organic
brain dysfunction. Also, trauma to the genitals such as
the crushing, wringing or pulling of the scrotum or direct
trauma to the region can result in complaint of pain and
sensitivity and hyperaemia (redness due to increase
blood flow); marked swelling and bruises can also be
observed.300 Even if physical findings are not observed,
sexual torture is often associated with subsequent
sexual dysfunction.
It is important to note that only a minority of survivors of torture and/or ill-treatment may present with
permanent scarring, and the scars are frequently subtle
or non-specific.301 Scars due to external traumatic injuries (sharp objects, blunt objects, thermal or electrical
sources) result when there is penetration through the
entire thickness of the skin. A scar results from the
response of the body to repair the injury. Scars may or
may not reflect the nature of the object that caused the
injury. It may not be possible to extrapolate the appearance of the scar to the type of object that caused the
injury. In addition, many scars are non-specific, in that
scars are consistent with injuries made by a multitude of
objects. It is not possible to determine the age of scars
“Palestinian-type suspension” consists of suspending the victim with
one hand facing forward and the other one facing backwards. Grethe
Skylv, Physical Sequelae of Torture, in Torture and Its Consequences —
Current Treatment Approaches 39 (Metin Basoglu, ed. 1992).

298 

Istanbul Protocol, supra note 7, § 209, at 38.

299 �

Id., § 228, at 41.

300 �

Alejandro Moreno & Michael A. Grodin, Photo Essay, The Not-SoSilent Marks of Torture, 284 JAMA 538 (2000).	

301  

by their appearance. Further, since most lesions heal
within about six weeks of torture, leaving no scars or
non-specific scars, a characteristic history of the acute
lesions and their development until healing might be the
only support of an allegation of torture.302
In some cases, medical diagnosis tests are valuable
supporting evidence.303 However the absence of a positive

diagnostic test result must not be used to suggest that
torture did not occur.304
In conclusion, it is important to note that, “the absence
of…physical evidence should not be construed to suggest
that torture did not occur, since such acts of violence
against persons frequently leave no marks or permanent scars.”305

Istanbul Protocol, supra note 7, § 2188, at 35.

304 �

Id., § 232, at 42.

305 �

302 �
303 �

Id. at 42.
Id. at 31.

A ppendix   1 2 1