A Health and Human Rights article in this week’s issue of THE LANCET highlights how US Army medical personnel at Iraq’s Abu Ghraib prison ignored medical ethics and human rights standards and were complicit with human rights abuses of Iraqi prisoners. The author of the article concludes that a comprehensive inquiry into the behaviour of medical personnel in places such as Abu Ghraib is needed to reform the military health system.’
The treatment of prisoners and the behaviour of some US Army personnel has received widespread media coverage over the past few months. The role of medical military staff in the Abu Ghraib affair has, however, been less widely reported. Steven H Miles (University of Minnesota, USA) has reviewed media reports and available government documents. He highlights how the failure of medical staff to carry out their duties within the framework of the Geneva Convention and other human rights standards adversely affected the treatment of prisoners.
Key failings of medical staff include: failure to maintain medical records, conduct routine medical examinations, and to provide proper care of disabled or injured detainees. Medical personnel and medical information was also used to design and implement psychologically and physically coercive interrogations. Death certificates and medical records were falsified.
Dr Miles describes the following case as exemplifying the failings of medical personnel in Iraq’s detention centers. In November, 2003, Iraqi Major General Mowhoush's head was pushed into a sleeping bag while interrogators sat on his chest. He died; medics could not resuscitate him, and a surgeon stated that he died of natural causes. Months later, the Pentagon released a death certificate calling the death a homicide by asphyxia. Although knowledge of torture and degrading treatment was widespread at Abu Ghraib and known to medical personnel, there is no report before the January 2004 Army investigation of military health personnel reporting abuse, degradation, or signs of torture.
A comprehensive investigation of the performance of the military medical system is needed to serve as a basis for reforms. Dr Miles concludes: “At this time, it is not possible to know the absolute or relative prevalence of the various abuses or fully assess the performance of military medical personnel with regard to human rights abuses. Army investigations have looked at a small set of human rights abuses, but have not investigated reports from human rights organisations, nor have they focused on the role of medical personnel or examined detention centres that were not operated by the Army. The US military medical services, human rights groups, legal and medical academics, and health professional associations should jointly and comprehensively review this material in light of US and international law, medical ethics, the military code of justice, military training, the system for handling reports of human rights abuses, and standards for the treatment of detainees. Reforms stemming from such an inquiry could yet create a valuable legacy from the ruins of Abu Ghraib.”
This week’s lead editorial discusses the crucial role of medical staff in upholding ethical values to combat the abuse and torture of prisoners. It comments: ‘Military doctors can be placed in a difficult position, but the problem of dual loyalty, to patients and to their employers, is well recognised. Guidelines and codes of practice state that doctors, even in military forces, must first and foremost be concerned about their patients and bound by principles of medical ethics. Given these events, the World Medical Association saw the need to re-emphasise its strong and unambiguous 1975 Tokyo Declaration in June: “Doctors shall not countenance, condone, or participate in torture or other forms of degrading procedures . . . in all situations, including armed conflict and civil strife”.
As one of the other few medical bodies to speak out, members of Physicians for Human Rights wrote an open letter on Aug 6 to James Schlesinger, Chair of the independent panel to review US Department of Defense detention operations (and due to report later this month), questioning the role and use of physicians and other medical personnel in detention centres in Afghanistan, Iraq, and Guantanamo Bay. Health-care workers should now break their silence. Those who were involved in or witnessed ill-treatment need to give a full and accurate account of events at Abu Ghraib and Guantanamo Bay. Those who are still in positions where dual commitments prevent them from putting the rights of their patients above other interests, should protest loudly and refuse cooperation with authorities. The wider non-military medical community should unite in support of their colleagues and condemn torture and inhumane and degrading practices against detainees. Abu Ghraib should serve as an eleventh hour wake-up call for the western world to rediscover and live by the values enshrined in its international treaties and democratic constitutions’.