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Profile 8: Haydar

This is the summary of a medical examination of former Guantánamo prisoner Haydar (not his real name).46 This examination was carried out under the auspices of Physicians for Human Rights by a team consisting of a physician and a psychologist/psychiatrist. The summary is taken from pages 46-50 of the Physicians for Human Rights' report Broken Laws, Broken Lives: Medical Evidence of Torture by US Personnel and its Impact, published in June 2008.


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.

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 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 periodically 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.”

Medical Evaluation

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 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

Assessment of Psychological Evidence
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 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 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.

Notes

46. Haydar’s medical evaluation was conducted by Allen Keller, MD and Barry Rosenfeld, PhD.

47. 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.

48. 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.

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