Profile 11: Rasheed
This is the summary of a medical examination of former Guantánamo prisoner Rasheed (not his real name).59 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 61-71 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.
Rasheed was originally detained in Afghanistan at the end of November 2001. He was held by US forces at Bagram, Kandahar, and Guantánamo. He was subjected to a range of abuse including prolonged isolation, sensory deprivation, forced nudity, beatings, various injections, unwanted medical procedures, forced shaving and exposure to cold temperature and loud noises. In the fall of 2006, Rasheed was released from Guantánamo. The medical evaluation reveals a wide range of physical ailments due to injuries endured during detention. He is currently suffering from complex PTSD and somatization disorder due to severe sequential traumatization by US forces.
“I am not the person I used to be. I have lost my kind attitude to people, I lost my nerves. I have turned [completely].”
Background
Rasheed is in his mid-thirties. After he finished high school, he attended a center for scientific research and became an engineer. He is married and has two young daughters. He lost two sons when they were infants. He converted to Islam in the mid-1990s. A few years later, when he refused to shave his beard and renounce his religion, he lost his job at a company as a result of his government’s anti-Islamic stance. He then made a living by repairing audio players and working as a private construction worker. In 2000,60 the police of his home country arrested him and held him on assertions of terrorism. While in custody, Rasheed was badly beaten on his head, back and abdomen. He reported that he lost consciousness, vomited and had blood in his urine.
Rasheed recounted that after his release, he was told by government officials that he either had to leave the country or he would be taken to prison. He fled his homeland in early 2001, and was forced to live in a transitory refugee camp in another country for four months. Rasheed reported that, because he did not have proper legal documents, government officials of the country in which he had sought refuge then flew him out of that country and into Afghanistan where he resided until the war began. In Afghanistan, he worked in various jobs, including as an engineer on the lighting system of a local mosque.
Allegations of Arrest and Abuse
At the end of November 2001, when the US war in Afghanistan began, the members of the village in which Rasheed resided fled into the mountains where they stayed for a few months. Rasheed reported that one day, members of the village were stopped by bandits. He was abducted by the bandits, who sold him to US and Northern Alliance troops who were searching for insurgents and “offering $3000 for a captured insurgent.”
In April 2002, he was taken to Kunduz, Afghanistan in handcuffs, with his eyes covered with goggles. His clothes were cut off and his body was searched, including “impossible” places. Rasheed recalled that he was beaten and remained confined and naked on a concrete floor. Because he was not allowed to go to the toilet, he recalled that he “defecated on the floor and spent the night in [my] feces.”
In May 2002, Rasheed recalled being taken to Mazari-Sharif where he was beaten severely to the point of unconsciousness. Rasheed noted that when he woke up, he felt pain under his ribs, over his kidneys and in the area of his liver, and had blood in his urine. After three days, he was transferred by airplane to the military base in Bagram.61
Bagram and Kandahar Prisons, Afghanistan
Rasheed reported that he was beaten by US soldiers during his transfer by plane to Bagram. He recalled that he stayed fourteen days in Bagram, where he was put in a cage and was interrogated over long periods of time. During the first two lengthy interrogations, he was not beaten; he was only hooded. During the third interrogation, he reported that he was hooded, repeatedly beaten by blows and kicked in his abdomen. As a result of the beatings, his head struck the ground and he lost consciousness.
When he woke up, he found himself in a clean room. He had a painful large swelling in his right lower abdomen. He recalled asking to see a doctor. Someone whom he perceived to be a doctor subsequently took blood and urine samples. Rasheed recalled that at that point he “wanted to die” because of the intense pain. However, against his will, Rasheed was held down by force and was given an unknown injection. He recounted that he woke up in a military hospital after having had a medical procedure without his consent, without information about the type of procedure, and against his wishes. Rasheed was told the swelling was not his appendix, but the nature of the operation was not disclosed.62
Rasheed recounted that while he was hospitalized he was handcuffed and tied to the bed with a leather strap. Rasheed recalled that his pain and the swelling remained present. When he was released from the military hospital after four days, two soldiers had to carry him because he could not move on his own.
Soon after his surgery, the Americans transferred Rasheed to Kandahar. During the flight, although he was in very bad health and only recently had undergone the operation described above, he was hooded, and his hands and feet were shackled and tightly tied together. Rasheed recalled that his knees were tied in a kneeling position by adhesive tape. In this painful position, he was tied to the floor and was unable to move.
Upon arrival in Kandahar, Rasheed recounted that the US soldiers cut off all his clothes and stripped him naked. His hands and legs were in shackles and he was forced to wear goggles and earphones that prevented him from seeing and hearing. He was tied to a table with his hands behind his back. Rasheed reported that female soldiers sat on the detainees, took photographs, beat them on the head, and humiliated them by laughing and offending their religion.
After approximately two hours, Rasheed reported that the American soldiers tied him and the other detainees together with a rope and dragged them about 200 meters along a rocky pathway. He recalled that when he screamed because of the ongoing pain in his abdomen, the soldiers pushed his face forcefully down on the ground. The detainees were brought into a tent, where it was extremely hot; he felt it to be approximately 100 degrees Fahrenheit. Rasheed recounted that he was kept in the tent for about twenty days; he felt very sick. For the first seven to nine days he couldn’t eat anything and requested to see a doctor. The soldiers told him they did not have a doctor. At that point, the swelling in his abdomen was “the size of half an orange,” and its color had become black and blue. Rasheed noted that it took more than six months for him to recover fully from the pain and the swelling in his abdomen, and he received no medical treatment for his condition during that time.
Rasheed described that during his detention in Kandahar, he was unable to sleep because the soldiers played loud US rock music all the time. Rasheed also reported that the soldiers would unleash dogs on the detainees.
Guantánamo Bay
In early summer of 2002, after he had been in Kandahar for approximately one month, the guards shaved Rasheed’s head and beard and transferred him to Guantánamo. During the cross-Atlantic flight he approximated as “twenty-two hours,” he recalled that he was shackled, his hands were fixed in stiff gloves, and goggles, a respirator mask, and earphones prevented him from hearing or seeing. Rasheed recalled that during the flight, the detainees were hit on the head very hard if they moved.
Upon arrival at Guantánamo American guards stripped detainees naked while their hands and feet were in shackles and conducted body cavity searches. Rasheed was taken to a block where he was interrogated several times with an interpreter. Rasheed reported that between interrogations he was chained to the floor. He recalled that the interrogators asked him the same questions over and over again, and he was threatened that he would “be forced to tell the truth.”
Rasheed recalled that these frequent and lengthy interrogations were carried out while he was kept in an isolation cell for five days and was deprived of his blankets. He recalled that his cell was kept very cold and that he had blood in his urine again and suffered from nausea and vomiting. However, he did not receive any medical attention. Rasheed reported that he was given very little food and was extremely hungry. He recalled that he could not sleep because there was a constant, very loud, unpleasant noise and “every fifteen minutes the guards banged loudly on the doors.” Further, Rasheed noted that the guards walked around with truncheons and dogs and threatened to unleash the dogs on detainees. In one incident, Rasheed described that the guards tried to remove his shirt and shorts by force. He reported that when he resisted, two or three soldiers pushed him against the wall, and as a result, his head started bleeding.
According to Rasheed, after he complained to the commander and threatened to do “wild things with them,” he was transferred to another block where the overall conditions were better, and he was given sufficient food. Rasheed recalled that during that time, he was interrogated by a “more friendly FBI-man” about military equipment, which he knew about from his service in his home country’s army. Later, he was interrogated by a man from the military. Rasheed recounted that this interrogator tied him to the ground, threatened and shouted at him, pressed on his throat to the point of choking, and hit him in the chest and the jaw. Subsequently, he experienced swelling of the jaw and pain with chewing. The interrogator accused Rasheed of being a leader of Al Qaeda and a terrorist group in his home country and working with the Taliban. He recalled that the interrogator also said that Rasheed was mentally ill and threatened to extradite him to his home country where Rasheed would be tortured. When Rasheed refused to cooperate, he said that interrogators used a different approach involving a female interrogator acting in a sexual and provocative way. Rasheed recalled that this interrogator apologized for the rude behavior of her predecessor and came very close to him, touched his knees and talked to him in a seductive way. This was a very shameful experience and very hard for him to tolerate.
To avoid further interrogations, Rasheed said that he behaved as if he was mentally unstable. He reported that he shouted and threw his urine at guards. According to Rasheed, they did not punish him but his behavior compelled the guards to call in psychologists. Rasheed recalled that approximately every two days, two psychologists, a man and a woman, came and asked him whether he intended to commit suicide or harm himself. There was a big red cross on his file and on his door, which indicated to him that he was considered “abnormal.” Officials took away all items with which he could use to harm himself. Rasheed recalled that he was feeling under intense pressure, and one day he managed to find a “device” that he could use to hang himself. He also was able to simultaneously manipulate the lock of his cell door, so the guards could not enter. He threatened to hang himself unless the soldier who threatened and harassed him was punished. According to Rasheed, it appeared to him “they signed a contract that they would not bother [him] any longer.”
After two months, Rasheed was transferred to block “Delta,” which he believed was especially constructed for detainees “who caused problems.” Rasheed recalled that Delta block consisted of special medical blocks, numbered 25-30, with observation cells equipped with camera surveillance. According to Rasheed, it was staffed by Navy personnel, consisting of one nurse, two “psych techs” who gave out the pills, and eight other assisting soldiers. Every two weeks a doctor with the rank of a colonel made rounds. During his first eleven months in block Delta, there was a female “psychological commander,” who prohibited the soldiers guarding the block from harassing the detainees. According to Rasheed, she was replaced by a new commander who he believed was “educated to break us down.”
In Delta block, Rasheed stated that he was forced to take a minimum of six unknown tablets four times a day. The commander threatened that if Rasheed did not take his medication, he would be given forced injections. Rasheed stated that he was repeatedly given injections against his wishes, which “brought [me] down to [my] knees.” He stated that the injections would make him “lose [his] mind” and sleep for about three days. When he woke up, all his joints and his skin were aching as if “a burning iron” had been forced against him. He reported that the injections made him feel an unbearable heat spreading through his body and caused him to get tears in his eyes and lose his memory. Rasheed recalled that he felt sick, asphyxiated, under enormous pressure, and had an extreme desire to escape. He felt “so miserable that [he] didn’t want to live anymore.”63
Rasheed stayed in Delta block for almost one year between December 2002 and December 2003. He remembered that during confinement in Camp Delta, he tried to commit suicide several times. He reported: “they wanted to turn us into robots, humiliate us; they made fun of us. The soldiers were having a good time.”
According to Rasheed, there was one “doctor” who tried to help the detainees, and one soldier who showed compassion. Rasheed recalled that the doctor informed the detainees about new strategies that were planned to break them down and warned them “that there was a spy among them.” The detainees employed collective actions to protest against the conditions. Rasheed recalled that some detainees tried to hang themselves, cut their veins with razor blades or bang their heads against the walls. A hunger strike was organized for about ten days, and the participants demanded to leave the block. Rasheed reported that he did not observe any force-feeding in his block, but in other blocks he saw detainees with feeding tubes and intravenous drips tied to their beds. According to Rasheed, the hunger strikers were eventually released from Delta block under the condition that they would stop rebelling.
Subsequently, he was transferred out of Delta block to another block which had medium security and which he believes served as a transition block to Camp Four, which for many was a transition block to repatriation out of Guantánamo. Rasheed’s medication regimen was continued there. He had to take three to six pills four times a day, with similar health impact, making him mentally unstable and sleeping for approximately three days. Rasheed mentioned that he avoided talking to the guards. He reported that he “had no strength,” could not eat, had “very strong saliva“, and his hands and feet trembled. Moreover, he reported that every month he got a forced injection. After these injections, he would feel “like a piece of wood, completely stiff like a statue, not like a human being.” He said he could not comprehend what happened around him and frequently had nightmares. Rasheed reported that he tried to avoid taking all these tablets by hiding them. However, the staff would regularly do a blood test on him to see whether he was taking the medication. Rasheed described a number of occasions in which, during cell searches, guards stamped on the Koran with their feet. He recalled that the detainees in all five blocks had a simultaneous uprising to oppose such practices. The detainees banged their heads against the walls and demanded “an end to the mocking of their religion.” Rasheed recalled that armored vehicles arrived with 200-300 soldiers. According to Rasheed, a commanding officer negotiated with the detainees, and after the officer “promised that the guards guilty of offending their religion would be punished,” the detainees stopped their protest.
During his detention in Guantánamo, Rasheed reported that he was beaten approximately every two or three days. He estimates that he was beaten about 300 times. Right after the first beatings in Guantánamo, he suffered from chronic headaches. Rasheed reported that for long periods of time in Guantánamo, he was not given enough water. According to Rasheed the delivery of water served in part as a means to enforce his compliance with taking psychopharmacological drugs.
In the fall of 2006, Rasheed was released from Guantánamo without any charges being brought against him. Rasheed described many difficulties following his release. He continues to live far away from his family and community. He also reported being unemployed and carrying the stigma of being a former Guantánamo detainee. Rasheed stated that the transitional facility in which he had been living at the time of the interview —which was surrounded by barbed wire, with massive iron barred windows and guards — constantly reminded him of Guantánamo. He distrusts the authority figures tasked to support him and is angry about what he perceives as dishonesty. He noted: “I am not the person I used to be, I have lost my kind attitude to people, I lost my nerves. I have turned [completely].”
Summary of Guantánamo Medical File
Rasheed provided his consent for PHR evaluators to be allowed access to his 1200-page, very detailed and extensive medical file from Guantánamo.
Summary of medical notes during the first year of detention: Summer of 2002-Summer of 2003
Rasheed’s admission diagnosis in Guantánamo disclosed that he had chronic watery diarrhea, right inguinal hernia repair versus (illegible writing), dental abscess, history of gastritis, probable irritable bowel syndrome, and intermittent headaches.
In July 23, 2002, a first suicide attempt by hanging is documented. Audiovisual hallucinations and selfinjurious behavior are also reported. In an evaluation in Camp Delta, the Behavioral Health Science (BHS) team noted personal and family history of psychiatric disturbance as well as a history of excessive drinking and use of marijuana. Rasheed was diagnosed with Major Depressive Disorder (MDD) with psychotic features and treated with sedatives, neuroleptics and antidepressants. The medical file noted that Rasheed was held in “legal isolation” although the file did not make clear what that was. A couple of days later he showed severe agitation and self-mutilation behavior (cutting himself, banging his head against the wall), and was put in restraints (shackled and helmeted), and his “comfort items”64 were taken away.
On July 27, 2002, the “psych” noted: “[W]ill rule out personality disorder cluster ‘c’ and leave MDD as provisional for now.” On August 8, the diagnosis “psychosis versus attention seeking behavior” is listed. On September 18, 2002, after a suicide attempt by hanging, Rasheed was diagnosed with Personality Disorder (PD). The psych noted: “Pt. [patient] has a history of maladaptive coping and manipulation behavior including dramatic and extreme behavior (e.g., self-mutilation, writing in blood, pseudo-seizures) to deal with [detention] stress. This self-injurious behavior is another episode characteristic of severe Personality Disorder with borderline [and] antisocial features.”
Rasheed continuously complained of audiovisual hallucinations with violent images of destruction, killing and blood. On July 29, 2002, the notes stated: “[C]laims to have been tortured by Americans in beginning of May of 2002. He reported hearing screams and seeing people taking children away, people with body limbs gone and burning. States the voices said he failed his missions. Claimed that he was reliving past experiences.”
Symptoms of severe depression as well as suicide intentions are noted with two more suicide attempts, one by ingesting two ice packs containing ammonium chloride and one by hanging. The notes indicated that Rasheed frequently requested that he be placed with a prisoner who speaks his language and that his loneliness [being kept in isolation] seemed to worsen his condition.
The medical notes indicate that Rasheed was in a constant struggle with the staff, who used physical restraints and prescribed medication, including sedatives, neuroleptics, and antidepressants to control Rasheed’s behavior. The staff wrote: “Hx [history] of palming drugs! Be Aware!” On other occasions, blood was forcibly drawn to check his drug levels.
For some time, bottled water was used as a privilege. This “privilege” subsequently was taken away from him because staff felt he was using somatic complaints as a form of manipulation to get cold water. The medical files noted that he gets angry when “comfort items” are taken from him as a punishment for bad conduct, such as for yelling and spitting on guards. Later on, his blanket was taken away because it was reportedly used as a means of self-harm, and this is noted as a suicide prevention measure. The files noted that Rasheed complained that not having a blanket was a form of torture because he was exposed to cold temperatures at night. The files noted that he made dolls out of paper to give himself comfort.
Rasheed’s words are quoted in the notes by the staff and exhibit his significant despair and hopelessness: “I want the guards stop being mean to me. I made another doll so I could look at the woman in my dreams;” “guards are torturing me by laughing, pointing and saying things to me;” “I don’t know why I am cut off from the outside world, I do not want to live any longer.” Yet another noted, “It is this prison. This is worse than you just killed us. You are keeping this human body alive, but killing our souls.” On another occasion: “I am depressed and I just want to die.” The notes also recite that he “stated that the nightmares continue to bother me and it is driving me crazy.”
In October 2002, he was reported as participating in a hunger strike demanding: “Either send me home or prosecute me.”
He constantly verbalized frustration at not having another detainee who speaks his language with whom he could communicate. On October 28, 2002, the psychiatric staff’s response is quoted in the file: “informed him that psych had no control over that and told him to ask his interrogator to have him moved.”
On November 5, 2002, he was quoted as saying: “I want to move to the end of the cell block. There are people down there who can speak my language and I could take my mind off of these visions.” Three days later, the “psych” recommended approval of his request. The apparent rationale was that communicating with a detainee who speaks his language would help to relieve Rasheed’s psychotic symptoms and facilitate psychiatric care through receiving some reality feedback from the fellow detainees. After the move, Rasheed reported that he felt better since he was able to speak to his cell mate. The psych observed him as: “brighter affect, more animated.”
However, on November 20, 2002, the problems escalated. The notes quote Rasheed as saying: ”I made these dolls because they make me happy. I want to hurt myself all the time…I see two people here and they want to attack me. They are sitting in my cell telling me to hurt myself.” Thereafter, his dolls were taken away, he was placed on self-harm-prevention, and moved to another cell. Rasheed stated that he did not want to move away from his cellmates (who spoke his language), but according to the medical notes, the staff moved him to “prevent him from harming himself.” Two hours later, he expressed suicidal thoughts. One day later, he asked to be moved back to the cell with the detainees who spoke his language. When his request was refused, the file reports that Rasheed spat on the guards, was put in shackles and taken to the shower by the guard while his cell was searched without his presence.
A quote from the file on November 22, 2002 demonstrates the reasons the medical staff gave for Rasheed’s self-injurious behavior: “Pt. stated he is upset because the guards are laughing and pointing at him due to him banging his head on the cell. Complains of sharp pain in the back of his head and dizziness. Stated he bangs his head because “they” won’t give him his midraine for headaches….Discuss with pt. the reason medical did not give midraine because his pulse was too high. Told him that banging his head will only make it worse. Pt. educated on consequences of banging his head and that the guards said they’re going to put him in shackles if he does it again.” The medical staff withheld pain-killers for apparent medical reasons; he banged his head to protest which in turn worsened the headaches, a vicious cycle.
This oscillation of behavior continued during Rasheed’s entire first year of detention in Guantánamo. On April 10, 2003, he was put in restraints and isolation apparently for spitting at another “tech.” He stated he spat as a payback for an unjust blood drawn against his will and because his comfort items were taken away. The psychiatrist tried to calm Rasheed down and apologize for the blood draw. On April 20, 2003, Rasheed was observed socializing well with his cell mate, reading a dictionary and learning English. On May 2, 2003, he was reported as extremely agitated, yelling and cursing at staff, threatening to spit on military police, and cutting his forearm. Rasheed was given a cocktail injection of Ativan, Haldol and Benadryl and was placed in restraints.
Two notes from May 8, 2003 described Rasheed as: “in good spirits, no management problem”; and “detainee is social with staff and peers. Was noted to talk and laugh.”
On July 9, 2003, the doctor on duty observed Rasheed “as he was unresponsive and fell during interrogation with his feet buckled but did not hit head according to witnesses.” The medical files note that after being hydrated intravenously and given four milligrams Ativan, he became responsive and began talking slowly with slurred speech, complained of severe headache and chest pain. He was admitted to fleet hospital with a probable seizure, nonconvulsive status (seizure without observable movement abnormalities) versus psychiatric disorder.
From July 2003 until the fall of 2006, Rasheed’s medical records indicate that he suffered from a number of medical problems including a possible kidney stone and urinary tract infection, chronic diarrhea, chronic dyspepsia, knee pain, and fractures of his fourth and fifth fingers. He continued to suffer from chronic headaches and had a normal CAT scan of his head. During this period of time, the psych[] notes mention fewer active psychological problems. For example, no hallucinations are noted in the last year of detention; only “major depressive disorder with psychotic features”; “personality disorder NOS (Not Otherwise Specified)”, “narcissistic and antisocial features”; and “routine stressors of confinement” are mentioned. The last psychiatrist’s progress note did not record any active psychological symptoms or diagnoses; it simply listed: “history of noncompliance with treatment; narcissistic Personality Disorder with borderline features; history of hunger striking, history of suicide attempt (3/03), history of multiple suicide gestures including acts of self-harm by hanging or banging his head to the wall.”
Medical Evaluation
Reported Physical Symptoms
Rasheed currently complains of lumbar pain, pain in the renal lodges, headaches and chewing problems. He complains of loose teeth as well as problems with his knees. He suffers from pain in the right upper quadrant of his abdomen and has been suffering from stomach pain for several years. In the past five years, he suffered a few times from renal colic with blood in his urine. Rasheed reported that his vision decreased after release from Guantánamo. He was given contact lenses during detention.
Assessment of Physical Evidence
The physical examination revealed findings consistent with Rasheed’s allegations of torture. For example, the three-centimeter-long, linear irregular edged scar on his forehead is consisted with Rasheed’s description of the injury caused by being pushed against the wall in Guantánamo. According to Rasheed, during another beating he suffered a fracture of his hand bones. This allegation was corroborated with information in the medical file that noted that medical personnel splinted and buddy taped his right small finger and fourth digit. Further, the tenderness observed in his right hand is consistent with fracture of hand bones allegation, but needed to be confirmed by radiological examination.
Tenderness to palpation in the left and right lower quadrants and the 6.5-cm-long linear scar with partial irregularity in Rasheed’s right lower abdomen is consistent with reported surgical operation of unclear nature during detention in Kandahar. This surgery also is corroborated in the Guantánamo medical records which indicate a prior inguinal hernia repair.
The examination of the musculoskeletal system revealed findings that were consistent with his medical records and his description of his abusive treatment, including the observed tenderness on palpation of right hand, general tenderness in right and left lumbar area, the palpation to both sides in the costovertrebral angel (renal region), and the painful movements of the right knee.
Rasheed reported that during the initial beatings in Guantánamo, he began to suffer from chronic headaches. Rasheed stated that he was never given painkillers for his headaches or for pain in other parts of his body. In his medical files, though, delivery of pain killers is noted but sometimes withheld for medical and disciplinary reasons.
Medical Tests: As might be anticipated in a subject who has survived extensive physical and psychological abuse and, particularly, with the complicity of medical personnel, Rasheed was reluctant to allow a complete medical evaluation. He was suspicious and indicated that he believed that the medical evaluation would not help him. The following diagnostic tests and medical consultations have not yet been completed: neurologic, urologic, ophthalmologic and dental consultation. The evaluators believe that an orthopedic expert opinion, including bone scan, is needed to evaluate possible signs of non-visible, soft tissue and bone injuries resulting from blunt trauma during beatings. An X-ray of right hand, diagnostic imaging studies of the head and kidneys, and laboratory studies of blood and urine were all recommended.
Assessment of Psychological Evidence
Rasheed reported that he has not taken any medication since his release from Guantánamo. Following his release from Guantánamo, Rasheed reported suffering from frequent episodes of full body trembling. After an episode it is “as if [his] brain stops functioning” where he cannot type on his computer or “process information.” He suffers from flashbacks of his Guantánamo experiences. He described numerous symptoms of hyperarousal. For example, he continues to have difficulty sleeping. He has a disruptive sleep pattern, as he normally sleeps about six hours a night, from midnight to four A.M., then he wakes up and sleeps again from five to seven A.M. He reported that he loses his temper quickly, and he has a tendency to shout at people. Often, when there is a misunderstanding with others, Rasheed fantasizes he “is in a confrontation with a US soldier standing in front of [him].” Whenever he gets the impression of dishonesty or hypocrisy, he becomes enraged. In general, Rasheed reported that he has great difficulty trusting people.
Rasheed was very nervous and suspicious during and especially at the beginning of the medical evaluation. At times, the evaluators felt that they might not be able to complete the full evaluation. Rasheed was ill at ease, appeared to be constantly on edge and on alert. During the days in which the medical evaluation occurred, Rasheed was in a particularly difficult life situation as he had left the transitional facility in which he had been living for a variety of reasons, including that it was reminiscent of Guantánamo. Unlike any of the other interviewees, he was homeless at the time PHR’s medical evaluation occurred. He repeatedly expressed that he was frustrated and felt betrayed by everybody, especially the authorities at his place of residence. The evaluators arranged two nights in a hotel for him during the evaluation but could not offer any long-term support or social services, and few were available for his use. Rasheed’s anxieties were lessened by the second day of the evaluation when he was notified of an ability to move out of the transitional facility.
It is evident that Rasheed is deeply affected by what he went through during his short imprisonment and torture in his home country, and long-term confinement and torture in US military prisons in Afghanistan and in Guantánamo Bay. Rasheed suffered from memory intrusions, avoidance behavior and hyperarousal symptoms. He is constantly haunted by the memories of abuses he endured; he has sleeping problems, is extremely irritable and easily loses his temper. He is unable to concentrate and is extremely suspicious and hypervigilant. He reported that he has lost his basic trust in people, which extends to people who clearly support him. He said he believes that everyone makes false promises to him, and he expected that PHR evaluators would do the same. He suffered from dissociative states.65 This, as well as his almost paranoid suspicion and his extreme irritability, get him into trouble with people around him, including the authorities. He described how his personality has changed and that he felt that he is not the same person he used to be.
His symptoms, together with the results of the psychological tests, confirm the diagnosis of PTSD with somatization disorder. Rasheed carried all three symptom complexes — intrusion, hyperarousal and avoidance. Rasheed’s self-endangering behavior (that occurred while in custody), the change of his personality, his extreme mistrust, his tendency to isolate and alienate himself from other people and his dissociative states are clear signs of a more severe form of PTSD - Complex PTSD (C-PTSD). Rasheed’s symptoms of Complex PTSD are attributed to the repeated sequential traumatization during detention in his home country, in US custody in Afghanistan and the four-year detention in Guantánamo. Complex PTSD occurs in survivors of repeated on-going trauma. The symptoms include: explosive anger, amnesia, dissociative states, depersonalization, feelings of helplessness, loneliness, hopelessness and despair, social isolation, persistent thoughts of revenge, extreme mistrust, dysfunction in interpersonal relationships, and self-endangering behavior. 66
During the two days of the examination, the evaluators did not detect any signs of psychosis or personality disorder, and he did not express any suicidal thoughts.
Psychological Tests:67 On the self-report measures administered, Rasheed reported numerous symptoms of PTSD, anxiety, somatization, and depression. Rasheed’s responses to the Dot Counting Test, a clinician-administered test of symptom exaggeration, indicated he responded honestly with no evidence of deliberate exaggeration.
Analysis of Medical Records in Connection with PHR Evaluation
Rasheed reported no previous history of diseases or psychiatric illness and no family history of mental illness in his PHR evaluation. However, in July 2002, a medical evaluation by the Behavioral Health Science (BHS) team in Guantánamo states that Rasheed told the BHS team that he had headaches as a child which dissipated with age. These headaches returned after he was beaten by village people in a fight two years before his incarceration in Guantánamo. The medical file also indicated that he stated that he “heard and saw [imaginary] people” as a child. Rasheed reported to the BHS team that his mother had a similar problem. The files noted that he reported being hospitalized for eleven days in 1991 for psychiatric problems. The records also note that he indicated that his condition improved with medication.
In his first medical assessment upon arrival at Guantánamo, though, no psychiatric disorder was noted. Rasheed stated that he was repeatedly interrogated after his arrival. According to Rasheed, because he claimed to be innocent and did not confess to wrongdoings, the interrogators punished him with isolation, exposed him to cold temperature and loud noises, shackled him in painful positions, and deprived him of sleep. According to his medical file, about four weeks after his arrival in Guantánamo, and approximately half a year after his initial detention, he attempted to commit suicide for the first time, complained of audiovisual hallucinations and showed self-injurious behavior. These files demonstrated that his condition deteriorated steadily. Although the medical file indicates he was held in isolation, he was not removed from it. He complained of feeling lonely because he had no one to talk to in his language. When he asked to be moved to a cell with a cellmate who spoke his language, the “psych” staff told him that only his interrogator could grant him this privilege. Scientific studies name hallucinations, psychotic states and regressive behavior as frequent and typical effects of isolation.68 According to the medical file, Rasheed had audiovisual hallucinations and showed regressive behavior, i.e., making paper dolls and talking to them. This mental anguish is consistent with reports of agitation and self-injurious behavior in Rasheed’s medical file and his self-report.
As noted above, in evaluations of Rasheed after his suicide attempt, the BHS team at Guantánamo noted a history of psychiatric disorder, which Rasheed denied in the evaluation interview, possibly because he felt ashamed disclosing it. The details of that history are vague and the BHS team did not report any specific psychiatric diagnosis. He certainly was, and is, a very vulnerable person. It may be inferred that under the condition of extreme stress and maltreatment in detention a latent pre-existing psychiatric disorder recurred and exacerbated in terms of a major depression with several suicide attempts and psychosis. The BHS team attributed his aggressive outbursts, mood swings and self-injurious behavior as signs of borderline personality disorder. During his medical evaluation with PHR evaluators, and in his self-report, Rasheed said that he behaved like “a mental case” to avoid further interrogations. In fact, one can infer from his Guantánamo medical file that his abnormal behavior was at least partly intentional. Therefore his borderline behavior, and his reported selfhistory inside Guantánamo, may have been deliberate shamming to protect himself from ill-treatment and duress in Guantánamo. On the other hand, his abnormal behavior escalated whenever the guards punished or mistreated him. From the medical file one can conclude that he also behaved that way as a form of protest to his detention conditions.
In the medical files, Rasheed continuously complained of audiovisual hallucinations with violent images of destruction, killing and blood and told his caretakers that he “was reliving past experiences” and had “been tortured by Americans” while detained in Afghanistan. It is likely that, in fact, these hallucinations, in part, reflect his real experiences. According to the traumatic history Rasheed gave the PHR medical evaluators, he described in detail his beatings and torture after he was handed over by Northern Alliance troops to US forces and kept in several military prisons in Afghanistan.
After he was diagnosed by the BHS team as being mentally ill with a pre-detention history of psychiatric disorder, one would reasonably expect that Rasheed would be classified as a person with severe mental health problems and be taken off the ordinary prison regime. In particular, concern for his health would have led to removing him from isolation, which, at the very least, appears to have exacerbated his mental health problems. Instead, however, interrogators reportedly continued to subject him to solitary confinement, removed basic items such as his blanket and separated him from the other detainees who spoke his language. From the medical records, it appears that the psychologists, doctors, and nurses made some attempt to address Rasheed’s severe psychological symptoms. However, they did not evaluate Rasheed’s symptoms of PTSD, which Rasheed manifested early in his incarceration. Also his medical records do not indicate that he received supportive and verbal therapies. Instead, against his will, Rasheed was treated exclusively with psychopharmacological drugs, which were associated with severe side-effects. Moreover, the records do not indicate that the health professionals inquired into or documented any form of ill-treatment that Rasheed was enduring, much less the relationship between that ill-treatment and his mental condition. Under the circumstances, the psychiatrist’s and psych tech’s mention of “routine stressors of confinement” in their list of diagnoses seems to be a deliberate attempt to minimize the nature and extent of Rasheed’s psychological symptoms and to disregard cruel, inhuman and degrading treatment as a likely cause of these symptoms. It is possible, moreover, that the mental health interventions may even have worsened the suffering of Rasheed, by patching him up sufficiently so that further interrogation and torture could be inflicted. These all suggest that the health professionals either willingly or unwittingly aided the ill-treatment.
There is further supporting evidence that ill-treatment was the cause of Rasheed’s psychological symptoms. His psychotic and depressive symptoms lessened after he was transferred to blocks with less harsh conditions, including being transferred to Camp Four in August 2005, and subsided completely before his release. On July 7, 2005, the psychiatrist noted that Rasheed would be removed from the Behavioral Health Services Program because his Psychotic Disorder NOS (not otherwise specified) was considered stable. To the diagnosis Major Depressive Disorder, the words “Single Episode, Mild to Moderate” were added. In the last year of detention the diagnosis psychosis NOS was dropped, as well as the diagnosis of Major Depression in the last medical evaluation in October 2006. The only remaining psychiatric diagnosis, then, was narcissistic personality disorder with borderline features. The PHR evaluators believe that it is reasonable to infer that with the prospect of his imminent release, his symptoms of psychosis and depression resolved. At the same time, the PHR evaluators consider the diagnosis of personality disorder cluster B as questionable. Judgment of personality is very much shaped by cultural concepts and values. It is evident from the medical files that many of the problems between Rasheed and the Guantánamo staff, including the medical staff, may be attributed to ill-treatment, extremely stressful conditions of detention and intercultural communication problems. As stated above, Rasheed may have intentionally behaved like a borderline-case to protest against ill-treatment and avoid interrogations.
Rasheed told PHR evaluators that after being handed over to US forces and Northern Alliance troops in Afghanistan and held in Mazar-i-Sharif, and Bagram and Kandahar prisons, he was severely and repeatedly beaten on all parts of his body (e.g., kicked in his belly and head), that he lost consciousness and suffered from a severe abdominal trauma. In the military hospital in Bagram, he was told that he had to have an emergency operation on his kidney. Rasheed reported that when he woke up he was told it was “not an appendix”. Rasheed may have suffered from a strangulated inguinal or femoral hernia, an abnormal displacement of a loop of bowel through the abdominal wall and in association with compromised blood flow to the affected bowel segment. It is also possible that he was operated on for a trauma related injury such as a hematoma (collection of blood) or a contusion or rupture of an abdominal organ.
Rasheed had a pre-detention history of headaches. His chronic, severe headaches in detention are likely due to stress-related psychological symptoms, but also may be related to post-concussion effects of head trauma from beating that occurred in his home country, Bagram and Kandahar and his frequently noted self-harm behavior of banging his head against the wall in Guantánamo. He also reported one incident where his head started bleeding after Guantánamo guards pushed his head against the wall. The CT of the brain obtained on June 7, 2004 in Guantánamo did not demonstrate any significant abnormality, but this does not exclude the possibility of a post-concussion syndrome.
Analysis and Conclusions
The historical, physical, and psychological evidence strongly supports Rasheed’s allegations of torture and cruel, inhuman and degrading treatment.
Rasheed’s present mental and physical condition is fragile. He suffers from a wide range of physical complaints due to injuries endured during detention. Rasheed’s general mistrust in people made it very difficult to establish trust in the course of the medical and psychological evaluation. Some of his testing remains incomplete.
The medical history and physical examination support Rasheed’s report of multiple injuries, and are consistent with the abuses he described. For example, the linear scar on his forehead is consistent with allegations of his head being pushed against the wall by soldiers in Guantánamo. The medical examination also supports Rasheed’s history of having gone through an acute abdominal operation of an unclear nature in Kandahar. The fracture of two fingers of the right hand is consistent with the allegations of abuse but need to be confirmed by radiological examination.
Additionally, Rasheed described a history of chronic headaches that are most likely due to stress during detention and post-concussion syndrome after multiple episodes of head trauma from beatings during detention in his homeland, US military prisons in Bagram and Kandahar and self-harm behavior in Guantánamo.
Based on the self-report, the psychological tests, the evaluation of the Guantánamo medical file and clinical findings, Rasheed suffers from complex post-traumatic stress disorder with somatization disorder due to severe sequential traumatization by physical and psychological torture for a lesser period in a prison in his home country and over a long period of time in US military prisons in Afghanistan and Guantánamo. Rasheed described numerous symptoms indicative of PTSD, including intrusive thoughts and memories of the traumatic events (e.g., feeling haunted by the memories of his abuse), avoidance and emotional numbing behaviors (e.g., lost of basic trust in people, being extremely suspicious, dissociative states), and hyperarousal symptoms (e.g., sleep and concentration difficulties, anger and loss of control), and he shows self-endangering behavior. He further reported a change of his personality that has limited his ability to function, as he would like to, in daily life and interact with other people.
During detention in Guantánamo, Rasheed suffered from a three-year episode of major depression with several suicide attempts, psychosis and self-injurious behaviour. These conditions should be considered in connection with a likely pre-detention history of psychiatric disorder that recurred and exacerbated due to physical and psychological torture in US military prisons in Afghanistan and Guantánamo.
There are some contradictions and missing links in his self-reported history. On the one hand, Rasheed has an impressive memory; he remembers details, names, and dates that match with the data from his medical file. On the other hand, parts of his memory are fragmented. This combination of hypermnesia and hypomnesia is a typical post-traumatic symptom in survivors of severe trauma. We have no reason to doubt the credibility of Rasheed’s allegations. Moreover, Rasheed’s allegations of trauma are congruent and consistent with the information in his medical records. Also the clinician-administered test of symptom exaggeration indicated that Rasheed responded honestly with no evidence of deliberate exaggeration.
The question arises as to why an obviously sick and vulnerable person with a possible history of psychiatric disorder was kept in detention for four years and exposed to the full range of stressors of confinement, some of which amount to torture, in Guantánamo including long interrogations, physical abuse, verbal threats, prolonged isolation, exposure to cold temperature and loud noises, violation of religious and moral codes, and sexual humiliation. These stressors seriously exacerbated and/or caused the psychological symptoms observed in the medical files during detention, some of which have persisted to the present time. The Guantánamo medical file show that doctors and nurses provided Rasheed a high level of access to care. Although the motives of the medical personnel cannot be gleaned from a review of Rasheed’s medical record, it is clear that these individuals, particularly the mental health personnel, contributed to Rasheed’s stress-related psychological symptoms by not adequately identifying the cause of his psychological symptoms, failing to obtain his consent for medical interventions, and failing to seek an end to physically and psychologically destructive practices carried out by US interrogators and guards.
It appears that the clinicians involved in Rasheed’s care were negligent in their duty to inquire about and document possible evidence of torture and ill-treatment. In addition, they failed to recognize and address the causes of Rasheed’s profound psychological symptoms of complex PTSD.
Rasheed’s current mental and physical condition is negatively impacted by the fact that he has been uprooted, lives in poverty, and is socially isolated by being cut off from his family. Rasheed described his life since his release as an extension of his detention in Guantánamo. He has little opportunity for building a new life or finding a job. Further, no adequate health care and psychological support is available to him. Rasheed is in urgent need of social, psychological, and medical assistance and support.
Notes
59. Rasheed’s medical evaluation was conducted by Onder Ozkalipci, MD and Christian Pross, MD.
60. Rasheed reported to the evaluators that he was arrested in November 2001 by authorities in his home country. However, his date of arrest has subsequently been confirmed to be August 2000.
61. Rasheed did not identify the perpetuators of the abuse he endured before being transferred to US custody in Bagram (i.e., while being detained in Kunduz or transferred to Mazar-i-Sharif).
62. Rasheed’s Guantanamo medical file noted that he had an inguinal hernia repair in Bagram.
63. In addition to the above, Rasheed self-reported symptoms of strong saliva, trembling of feet and hands, and feeling stiff like a piece of wood after injections. These are typical symptoms of side effects after long-term treatment with neuroleptics and antidepressants — i.e., dyskinesia, parkinsonoid, photosensitivity.
64. Basic provisions in Guantánamo, referred to as “Comfort Items,” include: one copy of the Koran, one mattress, one sheet, one blanket, one prayer mat, one two-piece suit, one pair of flip-flop shoes, one prayer cap, one washcloth and towel, and one salt packet for seasoning food. The “comfort items” vary according to the location and classification of the detainee. These items could be removed as punishment or given as a reward for cooperation in interrogations or good conduct.
65. From a psychological perspective, dissociation is a protective activation of altered states of consciousness in reaction to overwhelming psychological trauma.
66. See Judith Herman, Complex PTSD: A Syndrome in Survivors of Prolonged and Repeated Trauma, 5 J. Traumatic Stress 377-91 (1992); Bessel A. van der Kolk et al., Disorders of Extreme Stress: The Empirical Foundation of a Complex Adaptation to Trauma, 18 J. Traumatic Stress 389-99 (2005).
67. 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).
68. See Peter Kempe & Jan Gross, Deprivationsforschung und Psychiatrie, Sonderdruck aus Psychiatrie der Gegenwart, Bd 1 u. 2. 2. Aufl., (1980); P. Kempe et al., Sensorische Deprivation als Methode in der Psychiatrie, 45 Nervenarzt 561-68 (1974); Craig Haney, Mental Health Issues in Long-Term Solitary and “Supermax” Confinement, 49 Crime & Delinquency 124-56 (Jan. 2003).
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