American soldiers often have a tough time with Arabic names, so to guards, he was just "Gus.'' To the world outside Abu Ghraib prison, he became an iconic figure, a naked, prostrate Iraqi prisoner crawling on the end of a leash held by Private Lynndie England, the pixyish Army Reserve clerk who posed in several of the infamous photographs that made the name Abu Ghraib synonymous with torture. Now, it emerges, there may be another dimension to Gus' story and certainly to the horrors of Abu Ghraib. In what amounted to a perversion of the traditional doctor's creed of "first, do no harm," the medical system at the prison became an instrument of abuse, by design and by neglect. As uncovered by legal scholars M. Gregg Bloche and Jonathan Marks, who conducted an inquiry published by the New England Journal of Medicine, not only were some military doctors at Abu Ghraib enlisted to help inflict distress on the prisoners, but also the scarcity of basic medical care was at times so severe that it created another kind of torture.
Medical personnel and others who worked at the prison tell TIME that, with straitjackets unavailable, tethers--like the leash on Gus--were put to use at Abu Ghraib to control unruly or mentally disturbed detainees, sometimes with the concurrence of a doctor. That such a restraint-- which is supposed to be placed around legs, arms or torsos--ended up instead around a man's neck seems to be a case of a medically condoned practice degenerating into abuse. But there was also medical disarray at the prison: amputations performed by nondoctors, chest tubes recycled from the dead to the living, a medic ordered, by one account, to cover up a homicide. That in itself would have made Abu Ghraib a scandal even without the acts of torture inflicted on the inmates by their guards.
In most cases, U.S. frontline troops in Iraq have received top-quality medical care, producing the lowest death rate of any military conflict in history. But the care at Abu Ghraib has often been at the other end of the scale of humane treatment, at least until recently. Although the prison was at times crowded with as many as 7,000 detainees, no U.S. doctor was in residence for most of 2003. Military officials say a few Iraqi doctors saw to minor illnesses but not major traumas. In a statement obtained by the American Civil Liberties Union, an Army medic based at Abu Ghraib spoke of examining from 800 to 900 detainees daily as they were admitted. If he worked a 12-hour day, that gave him less than a minute for each exam. Ken Davis, an MP who served at Abu Ghraib in late 2003, told TIME that he once escorted a prisoner who had broken his foot the day before and had still not received treatment. "He was in terrible pain," Davis recalled. "There was no doctor and really nothing we could do."
The medical understaffing and under-stocking of Abu Ghraib were felt most acutely after the prison came under shelling by insurgents. A doctor who served there recalled an attack last April when a mortar landed on an outdoor pen holding prisoners, killing at least 16 outright and wounding more than 60. Former prison personnel described how those attacks produced pandemonium, with panicked prisoners seeking treatment from what were at times very few, poorly equipped medical workers. "When somebody died, we just took out their chest tube and inserted it into another, living person," said National Guard Captain Kelly Parrson, a physician's assistant at Abu Ghraib in late 2003 and 2004 who experienced three such attacks and was seriously injured by a mortar. "There was no other choice because we did not have enough."
Parrson cited a dearth of catheters, correctly sized breathing tubes and orthopedic supplies, including casts used to treat bone fractures caused by shrapnel from high explosives. Items had to be reused with minimal sterilization or done without, he said. Glucose strips, used to measure blood sugar, were chronically in short supply, leading to haphazard insulin dosing for diabetics. On occasion, said Parrson, internists and he and other nonphysicians carried out amputations and other procedures usually performed by surgeons. "I took off an ankle and a lower leg," he recalls. "There was no one else, and if it was death or amputation, you just had to do it."
By the estimate of an officer who frequently visited Abu Ghraib and is a psychologist, some 5% of the prisoners suffered from mental illness. Yet, according to Dr. David Auch, commander of the reserve company supporting medical operations at the prison in 2003, for long periods there was no one to treat mental-health problems among the inmates, no doctor qualified to prescribe antipsychotic drugs and other medications that could have calmed mentally ill detainees and perhaps diminished the guards' use of physical restraints. Often the only psychiatrists or psychologists on site were part of so-called behavioral-science consultation teams, or "biscuits," which monitored interrogations and custom-designed methods to make them more effective. Those specialists do not function as physicians, the Army says.
Among the most disturbed prisoners at Abu Ghraib was a man--probably psychotic, according to a medical staff member--who habitually coated his body in fecal matter and repeatedly tried to harm himself--for instance, by banging his head against cell walls. At one point, Auch says, medics asked his advice on restraining the prisoner, reporting that they had used a helmet to protect his head and improvised padded gloves and plastic handcuffs to secure his arms. The medics wanted to know whether using a tether would be appropriate, and Auch recalls that he gave his assent, saying, "The priority is to safeguard the prisoner." A military spokesman told TIME that U.S. military personnel in Iraq do employ tethers--sometimes loosely affixed around a leg or an arm--to restrain some detainees undergoing medical treatment.
Auch says neither he nor any members of his medical staff were consulted about an Iraqi, later dubbed "Ice Man," when he was first brought to the prison for interrogation by military intelligence. "They didn't check the detainee medically when he came in," says Auch. That may have been a mistake. The man expired under questioning in the middle of the night in an episode that has been officially ruled a homicide. According to statements made during an Army inquiry, military personnel ordered the body put on ice and then spirited it away after medics attached a fake IV to the dead man's arm in an apparent attempt to create the impression that he was still alive. Auch, who says he has not been questioned in the Army investigation, told TIME a medic confided in him that he was ordered by a military-intelligence officer to participate in the ruse and never to talk about it. The Pentagon refuses to comment while it continues to investigate the abuses.
While the deficiencies in medical care at Abu Ghraib have gone largely unreported, the glare of the prison-guard scandal has compelled the U.S. military to launch major reforms. In the past year, the military says it has established a 52-bed hospital at the prison, staffed by 200 highly trained medical personnel. The number of detainees in U.S. custody is currently about 3,000. (The interim Iraqi government also houses prisoners there.) No date has been set, but the military would like to close the facility altogether, officially to avoid more insurgent attacks but, what's more, to wipe out the blot that is Abu Ghraib.
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