Doctors say medical transfer provision necessary in Defense bill

Congress is currently debating the FY2014 National Defense Authorization Act (NDAA), annual legislation that sets spending levels for most Department of Defense operations.  NDAA is not typically a bill that much concerns members of our profession, but this year's debate directly implicates our country's ability to provide proper medical care to the detainees at Guantanamo Bay. All physicians have a stake in that issue, and as doctors we feel compelled to weigh in.

Most of the details of the 162 remaining Guantanamo detainees and their plights are kept out of public view by protective orders, under the guise of “national security.”  That secrecy fuels a recurring narrative that Guantanamo holds some sort of terrorist supermen.  Our experience tells an entirely different story.

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Since 2008, we have jointly spent nearly a thousand hours in Guantanamo evaluating detainees and reviewing their medical records.  We have witnessed first-hand the inevitable:  the men are aging and their health is deteriorating.  Detainees are increasingly presenting with complex medical problems – cases of cardiovascular disease, cancer and serious mental illness will multiply with time.  After more than a decade in captivity, detainees’ medical needs are simply outstripping resources available to treat them. 

The United States is responsible, both legally and ethically, for providing proper medical care to detainees. Yet, under current law, no detainee can be brought to the United States for treatment, even if the treatment necessary to save a detainee’s life can’t be provided at Guantanamo.  That prohibition is indefensible.

Thankfully, a provision in the Senate version of the NDAA would lift it.  That provision – part of a much welcome package of reforms championed by Sen. Carl Levin (D-Mich.) that would facilitate closing Guantanamo, as President Obama has repeatedly said he wants to do – allows the Secretary of Defense flexibility to authorize the temporary transfer of Guantanamo detainees to a military medical facility in the United States, if necessary, to prevent death or imminent harm to a detainee’s health. 

The Senate took a huge step forward when, in a bipartisan vote, members rejected an amendment on the Senate floor that would have stripped out the reforms, including the medical transfer provision.  Although the Senate hasn’t yet voted on the NDAA as a whole, closed-door negotiations around a final bill are reportedly happening now among the chairmen and ranking members of the Senate and House Armed Services committees. 

At a minimum, it is critical that the medical transfer provision survive those negotiations. Two Guantanamo detainees for whom information has become public help illustrate why.

Tarek El Sawah, an Egyptian who arrived in Guantanamo in May 2002, is a complicated and high-risk medical patient. Over the last decade, three former GTMO commanders have written declarations affirming their belief that he does not pose a significant danger to the security of the United States and should be released.  During that same time, Mr. El Sawah’s weight has more than doubled – to over 400 pounds.  That is no accident; interrogators appear to have exploited Mr. El Sawah’s significant psychological vulnerabilities and enticed him with excessive amounts of food for “information.”  He now suffers from a multitude of serious physical and psychiatric illnesses; even walking is difficult.  Evaluation and treatment has been delayed for years. The rapid turnover of medical professionals has impeded meaningful continuity of care, which is a fundamental requirement when caring for complex medical patients like Mr. El Sawah.  It is remarkable that we (as medical consultants for his defense team) have had more continuity than any military doctors charged with his care in 11 years of detention.

Another example is Adnan Farhan Abdul Latif, who died by alleged suicide in September 2012, years after he had been cleared for transfer out of Guantanamo.  Mr. Latif was seriously mentally ill with multiple prior suicide attempts and suffered from traumatic brain injury and documented neurological deficits.  A report by U.S. Southern Command cited lapses in procedures that contributed to his death, and depicts woefully substandard medical care. Mr. Latif required tertiary neuropsychiatric care that was not available at Guantanamo, and it is possible he would be alive if he had had access to the proper care.

Guantanamo Bay does not have the capacity for sophisticated medical care necessary to treat patients like Mr. El Sawah, Mr. Latif, and others who have or will develop chronic health conditions as the detainee population continues to age.  This is an alarming problem, not just for detainees and the military, but for our medical profession as a whole.

On December 2, The Constitution Project and Global Lawyers and Physicians co-sponsored a conference involving national and international professional medical organizations to seek ways to ensure that Guantanamo detainees receive proper ethical medical care, and that military physicians have the support they need to provide it. Preserving the medical transfer provision in the NDAA is a critical first step. It should be passed and immediately pursued for Mr. El Sawah and others like him, so they do not die as they wait for justice.  It is already too late for Mr. Latif.

Crosby is a professor of Medicine at Boston University, specializing in internal medicine, and was one of the first doctors allowed to travel to Cuba to independently examine Guantanamo captives.  Xenakis is a retired U.S. Army Brigadier General who served for 28 years as a medical corps officer with assignments as a clinical psychiatrist, staff officer, and senior commander, including Commanding General of the Southeast Army Regional Medical Command.

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