—Declaration of Tokyo, World Medical Association (1975)

Physicians and other medical professionals swear to do no harm. But some United States military medical professionals have been implicated in the neglect and abuse of prisoners in the war on terror in Iraq, Afghanistan and Guantánamo Bay. They have betrayed their oath as healers by failing to provide adequate medical care, altering documents to cover up torture and homicide, force feeding prisoners, designing and monitoring coercive interrogation — and remaining silent rather than reporting these abuses, these crimes of war.

In his shocking and acclaimed book, Oath Betrayed: Torture, Medical Complicity and the War on Terror, Steven H. Miles, M.D., details the role of healthcare professionals in military prisons, and Bush Administration policies that have undermined the United States as a leader in international human rights — based on his review of over 35,000 pages of government documents and unprecedented eyewitness accounts.

Like most Americans, Dr. Miles was horrified by the photographs of tortured and abused detainees at the US prison in Baghdad, Abu Ghraib. And he immediately asked, “Where were the prison doctors when the abuses occurred?”

Dr. Miles is a professor of medicine at the University of Minnesota Medical School and a faculty member of its Center for Bioethics. He was the chief medical officer for a Cambodian refugee camp and worked on AIDS prevention in Sudan and on tsunami relief in Indonesia with the American Refugee Committee. He also worked with the Center for Victims of Torture, and is a recipient of the Distinguished Service Award of the American Society of Bioethics and Humanities.

Dr. Miles discussed with Real Change his research and ethical concerns about the role of healthcare professionals in torture.

Real Change: What sparked your book on medical complicity and torture?

Dr. Steven Miles: When the pictures of inmate abuse from Abu Ghraib prison came out, it was clear that there had to be doctors who were aware of this abuse because doctors are in every prison at all times. They see the prisoners the Red Cross never gets to, and they are there when the Red Cross isn’t. So they saw the abuse, or the signs of the abuse, and the question was why hadn’t they blown the whistle on it. That problem gets even more severe [because] these abuses [occurred in] a set of prisons: at least 20 in Iraq, a half dozen in Afghanistan, plus the Guantánamo complex. That raises the possibility [of] an overarching policy for medical involvement, which I think there is.

RC: Can you talk about these policies and the effect on medical treatment?

Dr. Miles: There were two policies. The first was set up by [Secretary of Defense Donald] Rumsfeld to engage health professionals in the design and monitoring of harsh interrogations, as outlined in an April 2003 document. Rumsfeld sent that document to Guantánamo where Gen. Jeffrey Miller [formed] BSCT’s [Behavioral Science Consultation Teams] that were headed by psychiatrists or psychologists who developed a two-pronged approach: First, a psychological approach to target the particular psychological vulnerabilities of Arab men: gender attack, attack on dietary rules, and so forth. Second, culling medical records and [designing] specific scripts to psychologically attack a particular prisoner. That embodied standard harsh interrogation techniques.

The second medical policy pertained to concealing deaths from torture. There was a standard procedure by which deaths from torture were concealed from the outside world at the level of the Armed Forces Institute of Pathology. There was a system of post-dating death certificates and failing to notify the outside death registry [in violation of the Geneva Conventions]. Also, pathologists remained silent as the Pentagon denied the deaths or falsely claimed these deaths were due to natural causes.

RC: In your extensive research of prisoner conditions, what abuses did you find?

Dr. Miles: Pretty much the whole array of sordid abuses that we see in any torturing society. Beatings, kicking, isolation, exposure to extremes of heat and cold, thermal and chemical burns, dietary and water restrictions, sexual degradation, threatening the relatives of prisoners, and so forth. The only abuse I did not see that is practiced in other torturing regimes [was] mutilation of prisoners. In some South American prisons, the cutting off of ears or hands has been common. I did not see mutilation, but I saw deaths — deaths preceded by prolonged, severe trauma.

RC: Did you find direct evidence that medical professionals were involved in abuses that led to death or serious injury?

Dr. Miles: Yes. The problem is that there are several sets of documents here. The Army documents were the ones most readily released. The Special Forces and CIA documents have been much harder to get. Also, we don’t have the documents from the [extraordinary] rendition interrogations, interrogations conducted in other countries that have very brutal histories. A log of an interrogation at Guantánamo [shows] that the physician and the medics were regularly in the interrogation room, [and] providing direct hands-on medical care during interrogation. Furthermore, a psychologist was in the room and supervising the use of, for example, military dogs to intimidate prisoners, and advising the interrogators on how to work over prisoners from a psychological standpoint. In addition, in a small number of cases, medical interrogators directly abused prisoners more or less gratuitously. For example, throwing IV bags at them, withholding pain medications, and allowing guards to sew up the prisoners’ lacerations the guards had inflicted. Beyond that, the health professionals were silent about the pattern of abuse.

Putting this in broader context, about 130 nations practice torture, and 60 percent of torture victims report seeing a doctor involved, essentially vetting the patient for torture, and that’s what happened in the United States circumstances.

RC: What are the ethical obligations of a military doctor who also must obey orders?

Dr. Miles: Ever since Nuremberg, we’ve said that [obeying orders] is an insufficient rationale [for ethical breaches]. We led the world in asserting that appeals to national sovereignty would not justify torture or genocide. The US Armed Forces and Department of Defense [is now] insensitive to the special role of health care professionals in prisons, and violates their own procedures for management of POWs. That does not let the physicians off the hook. Practicing physicians must understand their obligations.

RC: What can a physician do who witnesses or takes part in abuse or neglect?

Dr. Miles: A physician can report and protest up the chain of command, or alternatively go outside the chain of command to human rights agencies, as physicians have done in other torturing societies. I’m unsympathetic to the claim that they felt intimidated because, [in] other torturing societies, I almost always see that physicians have played a major role in [assuring that] those countries abandon torture at vastly greater risk than assumed by US health care professionals.

RC: And the homicides and torture are war crimes?

Dr. Miles: They are clearly war crimes. These are direct violations of Geneva Article Three, which prohibits torture and cruel, inhuman and degrading treatment. The Administration has committed grave breaches of the Geneva Conventions. I hope, if the United States is too weak to address these problems, the international human rights community proceeds with subpoenas and indictments of U.S. officials.

RC: Can you talk about officials whose actions led to these abuses?

Dr. Miles: Sure. Rumsfeld was certainly responsible for these abuses. Undersecretary of Military Intelligence [Stephen] Cambone was directly in the chain of command. Gen. Miller at Guantánamo, Lt. Gen. [Ricardo] Sanchez in Iraq, and probably Gen. [Dan] McNeil in Afghanistan are the senior officers who are responsible for these abuses. There’s a presumption in war crimes prosecutions [that you] start at the top rather than the bottom, unlike these little trials the United States has designed to limit responsibility rather than pursue responsibility for the fundamental problems in the prisons.

RC: You write that most detainees are not associated with al Qaeda or other terrorist groups.

Dr. Miles: The data in Iraq suggests that around 85 percent of the prisoners were innocent or ignorant of any insurgency or al Qaeda activity. In Guantánamo, 60 or 70 percent, but it may be higher because that data was collected after a number of non-involved people were released. Huge numbers of these prisoners were innocent.

RC: What are the global consequences of the Administration’s policy on torture?

Dr. Miles: It’s had multiple disastrous consequences. For example, when we asked [in 2004] for proper care for a Chinese dissident who was a friend to democracy in China, citing international law pertaining to prisoners, China told us to get lost. In addition, bad information from torture has had an adverse effect on US public policy. For example, we took a guy to Egypt, tortured him there, and he was the source of information that Saddam and al Qaeda were cooperating on bio-weapons, and that became part of the public argument for going into Iraq. The information was false and recanted by the guy as a torture-induced confession, [but] was used by [Secretary of State] Colin Powell before the UN and George Bush in his State of the Union address. Furthermore, a Marine intelligence official who was in Iraq from 2003 to 2005 told me we’re sending our troops on dangerous missions where they’re exposed to severe combat that are essentially wild-goose chases [based on] bad information procured by torture.

This has been a thorough disaster for the United States. We have destroyed the ability of the Geneva Conventions to protect our soldiers who become POWs.

We have seriously damaged our image in the world. If the United States had a chance to act as a midwife to a civil society in Iraq, we blew it with these abuses. The number of people in Iraq supporting our presence dropped from 75 to 25 percent after the Abu Ghraib pictures came out. We have simply lost our moral standing in Iraq. We have paid a tremendous price for a public policy, which was poorly thought out and recklessly embarked upon.

RC: What can professionals and average citizens do to stop torture?

Dr. Miles: It’s important for ordinary citizens to keep up the pressure. Medical societies [recently] moved into play, which is a welcome relief after they ignored this problem. Curiously, the legal community. while addressing the rights of prisoners, has been utterly unwilling to apply sanctions to its own members, the architects of these policy documents. [former Deputy Assistant Attorney General John C.] Yoo, [Attorney General Alberto] Gonzales, [former Attorney General John] Ashcroft … all of these attorneys continue to enjoy major positions of prestige and have not been pursued by bar associations for serious violations of international law. When a guy like Yoo writes the background memos for U.S. policy, that’s an act of legal culpability for which he should be held accountable.

Robin Lindley is a Seattle attorney and writer who covers international affairs, human rights, law, politics, medicine and the arts. He is a former chair of the World Peace through Law Section of the Washington State Bar Association.