Profile 9: Adeel
This is the summary of a medical examination of former Guantánamo prisoner Adeel (not his real name).49 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 50-56 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.
Adeel was originally detained in Pakistan in May 2002. He was transferred to US custody at Bagram military base and was subsequently transferred to Guantánamo. He was released in the fall of 2006, approximately two years after he was cleared to be released from Guantánamo. While in US custody, he was subjected to a range of abuse including prolonged isolation, stress positions, beatings, sexual humiliation, threats, forced nudity, religious humiliation, sleep deprivation, and food/water deprivation. The medical evaluation reveals physical and psychological evidence that strongly support Adeel’s allegations of ill-treatment. He is currently suffering from a major depressive episode and PTSD.
“For two months I couldn’t sleep because there was very strong light. We didn’t know if it was day or night. If you fell asleep just for a few minutes they played very loud American music, so you could not sleep.”
Background
Adeel is in his early forties. He grew up in a large family and received a professional degree in the health field. Adeel initially left his country to provide humanitarian services in the midst of the refugee crisis resulting from the Soviet occupation of Afghanistan more than a decade prior to his detention. However, he was unable to return home because of political problems in his country and the persecution of his family. Some of his brothers had been imprisoned and others had been killed. At the time of his arrest, he was living in Pakistan with his pregnant wife and five children and was working as a teacher for an international organization.
Allegations of Arrest and Abuse
Adeel reported that in May of 2002, Pakistani soldiers invaded his house at night, searching for a man of a different name and nationality. The Pakistani soldiers left after not finding this particular person, only to return a couple of hours later and arrest Adeel in front of his wife and children. Adeel reported that he was hooded and kept for nine days in a house that Pakistani intelligence services used as a prison. He was photographed and fingerprinted. He was not given enough food nor was he allowed to go to the toilet more than once a day. Adeel recalled that other than these deprivations, the Pakistani soldiers treated him fairly and he was not physically abused. After nine days, the Pakistani soldiers told him that he would be taken to Islamabad, but he, in fact, was transferred to Bagram military base in Afghanistan.
In Peshawar airport, he and other detainees were handed over to US soldiers. In the plane, the soldiers took all of Adeel’s belongings, handcuffed him and shackled his feet. Adeel reported that it was hot, and he was hooded, chained to the floor and tightly shackled around his chest and waist, which caused him to have difficulty breathing. According to Adeel, the flight from Peshawar to Bagram felt like it lasted about fifteen hours. Adeel recalled that there were more than fifty detainees on the plane who were all transferred in the same conditions as he was. He recalled that the soldiers beat the detainees if they moved and insulted them with humiliating words that included sexual humiliation. Adeel recalled that during the flight the American soldiers grabbed him by the throat and threatened to choke him.
Upon arrival at the Bagram airport, all of the detainees were tied to one rope and dragged along into a hall. The rope was tied very tightly around Adeel’s arm, which caused him severe pain. Soon after arriving, the detainees were taken one by one to a small room where they were forced to strip off all of their clothes. Adeel recalled that if they refused, they were beaten. He reported that he was subjected to a full body search in which the soldiers touched his private parts and also examined his body cavities including his anus, a treatment that he remembered as a particularly humiliating experience.
Adeel reported that at Bagram, he was never given any reason for his detention. He was kept for two months in a hangar in a compartment made of barbed wire and blankets. There were between twelve and to [sic] fifteen detainees in each compartment. “We were beaten every day in Bagram. You cannot move. If you move, you are punished. Punishment is suspension to barbed wire for one to two hours,” Adeel recalled. Moreover, he reported that he was beaten almost every day as a punishment for talking to other detainees. He recalled: “During those two months we were not allowed to speak any word.” Adeel recounted that in one incident when he recited the Koran while praying alone, the guards accused him of having spoken to another detainee. He was beaten and was chained to the barbed wire for several hours and “then I was taken to interrogations.” Adeel recalled that it was excruciating to be suspended that way since the barbed wire hurt him when he lost his balance.
Adeel reported that the guards did not let the detainees pray together, which he said is very important for Muslims. “They didn’t let us recite the Koran. They threw the Koran into the toilet in front of us,” stated Adeel.
Furthermore, Adeel recalled that the detainees were fed cold meals, uneatable moldy bread, cereal and candies. In Bagram, he noted that during the first two weeks, the detainees including himself were continuously handcuffed and had to eat while handcuffed. Adeel recalled that some detainees remained handcuffed for several months. Moreover, he did not have a mattress and had to sleep on the wooden floor, which was difficult and painful.
During his detention in Bagram, Adeel reported that he was not given a toothbrush and toothpaste. He therefore resorted to using a piece of a plastic bag to clean his teeth. However, the detainees were not allowed to keep any of the food packaging. He reported: “One day the guards found a very small plastic bag of candy. I wanted to keep it to clean my teeth. Then they beat all the persons in the hangar.”
He recalled that the detainees were only allowed to take showers with one to two liters of water. Adeel noted that he and other detainees had to use communal showers — “ten prisoners at the time had to remove their clothes” — and he found that very shameful. Adeel recalled: “It was not easy to use the toilet” because the toilet was in an open space without doors. He noted that using the toilet in an open space was very humiliating for Muslims, and consequently many detainees, including him, often did not eat in order to avoid using the toilet. He reported: “[I] didn’t go [to the toilet] for five days, because I didn’t want to go.” Adeel reported that during his detention in Bagram, he was constipated and suffered from severe renal and abdominal pain because the detainees were given limited water and because of his reluctance to use a toilet in public. Following Adeel’s complaint, a “doctor” ordered the guards to give him more water and his pain subsided.
Adeel reported that he could not sleep because the compartments in the hangar were lit with very strong lights twenty-four hours per day, and loud rock music was played all the time. He recalled that the detainees had to sleep with their hands above their blankets or otherwise they were punished. As a result of these conditions, he stated that he lost any sense of time, not being able to distinguish night and day: “For two months I couldn’t sleep because there was very strong light. We didn’t know if it was day or night. If you fell asleep just for a few minutes they played very loud American music, so you could not sleep.”
Between two weeks and a month into Adeel’s detention at Bagram, the detainees were allowed one by one to walk around inside the compartment for about ten minutes a day. Some of the detainees including him were never taken outside: “for two months I didn’t see the sun,” Adeel recalled.
Adeel reported that some female guards abused the detainees more than the men: “Females made more problems than men. They ordered punishments. If you didn’t obey, then ten [guards] would come and beat you… We were naked several times. It was very shameful for us.” He reported that the soldiers forcibly shaved his beard and head three times during his detention at Bagram. He noted one ICRC visit and that he was given Ibuprofen by the guards.
Adeel was interrogated two times for about three hours with the help of an interpreter. He stated that they suspected him of having worked for Al Qaeda in Afghanistan. He told his interrogators that he had not been to Afghanistan in the past decade and had been gainfully employed with an international organization. He reported that the interrogation stopped because, he believed, they could not confirm any of the accusations.
However, in early to mid-August 2002, Adeel was transferred to Guantánamo. During the transfer he was handcuffed, his feet chained to the floor and his body shackled very tightly to his chair. He was forced to wear a respiratory mask, black goggles, earphones with a humming sound, and long firm “special gloves so that you cannot move your fingers.” Adeel stated that the plane was specifically designed for the transfer of detainees as they sat in a row, chained to a single long seat with their hands, legs and waist chained. Adeel recounted that he could not move any body part except for his head during the approximately “twenty-four hour flight.” He recalled that the guards forced the detainees to take a drug that made him hallucinate. He imagined that the door of the airplane would open and he would fall out. After about six hours, they had to change planes, and he was dragged along by two guards. During this transfer, somebody touched him in a humiliating manner, which he considered the worst experience for him during those four years of detention. Due to its humiliating nature, he would not describe it in more detail.
Upon arrival in Guantánamo, the detainees were forced to stand outside while being exposed to the hot sun for five to eight hours. He asked permission to sit, which was refused. Adeel recalled that some of the detainees collapsed. He reported that a series of humiliating procedures similar to the one in Bagram followed: “They made the same examination as in Bagram — a, naked, forced anal examination. They took our pictures without clothes,” stated Adeel. He also recalled that a blood sample and chest X-ray were taken.
He was interrogated for approximately four to five hours, taken to a block in Camp II, and detained in a small isolation cell, which he described as a metal container with a bed with sheets and blankets, and a camping mat that was later replaced by a mattress. Adeel reported that his cell had a sink and a toilet and he estimated it to be about two meters in length and 1.5 meter in width. Adeel recalled, “Everything in [the] isolation [cell] was of iron.”According to Adeel, the cell was constantly air-conditioned and very cold. When he tried to block the air-conditioning vent with a piece of cloth, the guards would remove it. Adeel recounted that he was told he would be kept in such conditions and in isolation for one month. He noted that only during food delivery did he have the chance to exchange a few words with other detainees.
After two weeks in isolation, he was handcuffed and interrogated by someone he perceived to be a civilian who spoke Arabic. Adeel believed him to be a CIA agent based on the conversation. He recalled that this interrogator was very friendly, gave him good food, and offered to release Adeel if he was willing to work for the US government. If Adeel refused, the interrogator said, he “would stay in Guantánamo all his life.” Subsequently, Adeel was transferred to a different block, where conditions were somewhat better. He was kept in a “cage” but could freely talk to the other detainees.
Adeel noted that six months after his arrival to Guantánamo, he received a letter from his family via a Red Cross representative. He was subsequently allowed to send letters to his family every six to eight months during the periodic ICRC visits.
According to Adeel, the detention rules prohibited detainees from storing food in their cells. He recalled one detainee being punished with one month of isolation because he had kept an apple in his cell. Adeel noted that when the detainee reported this to the ICRC, this detainee was punished with an additional month of isolation after the Red Cross had left the camp.
While at Guantánamo, Adeel recounted an incident in which he refused to talk to an Arabic-speaking interrogator whom he thought was Lebanese, and he was punished with two weeks of isolation.
Adeel reported that after two months, he was transferred to a different block in Camp I, where he remained for seven months. According to Adeel, his conditions deteriorated. During Ramadan, he recalled receiving very little food that was given at ordinary meal times. He stated that he was always hungry. The food was of bad quality, and he noticed detainees were losing about ten to twelve kilograms. According to Adeel, once a week they were given a piece of meat the size of a matchbox. They were given water that was of a yellow color and that smelled of feces.50 Adeel avoided drinking it and subsequently got constipated and suffered from pain in the renal (kidney) region of his back. He described that most of the guards were very rude; they provoked the detainees, and he witnessed that they would punish detainees with handcuffing (shackling connecting the hands, feet and chest), checking body cavities and touching their “private area.” Adeel recalled that he could not sleep because the guards were always making loud noises, stepping on and cleaning the iron floors.
Adeel recalled that the detainees were kept in extreme isolation in parts of the Camp Echo, including in one area in which he was isolated for two weeks. He reported that everybody in that camp “went crazy.” According to Adeel, detainees were exposed to sounds and given lots of medications and injections. After two weeks in Camp Echo, he was taken to the interrogation room, and they asked him to cooperate with them. Again he refused.
He reported being fearful of being transferred to Camp X-Ray, where detainees were kept outdoors in cages, although Camp X-Ray had been closed by that time. The guards searched the cells with German Shepherd dogs. He noted the dogs jumping and barking at the detainees as a “very frightening experience.”
Adeel reported that he believed the guards planted suspicions among the detainees by spreading rumors that some of the detainees among them were informers, which some men believed to be true. He stated that every time he was transferred to a new camp, he saw detainees whispering about him, and this made him feel very lonely.
Adeel stated that he believed that because of good conduct, during the last two years of his confinement he was transferred to a more communal setting, in Camp 4. Adeel described this camp as a “luxury” compared to the other camps. However, he recalled that there were ten detainees and one bathroom per cell and that there was no space for privacy. Adeel recalled that regardless of the better conditions, he felt isolated and “bad.”
Finally, in the fall of 2006, he was released, without any charges being brought against him. Upon his transfer and release, Adeel recalled: “All the personal items that they had taken were not given back to me. They [released me] with only my clothes.” Despite his release, Adeel reported that he experiences discrimination as a result of his detention in Guantánamo and continues to face various obstacles to integrating back into his predetention life. He currently lives far away from his family and is unemployed with limited prospects for changing his situation.
Medical Evaluation
Reported Physical Symptoms
Adeel reported that, prior to his detention, he had surgery on his nasal bone, a tonsillectomy and a duodenal ulcer, for which he was treated and had no complaints thereafter. Apart from that, he reported that he was a healthy man prior to his arrest and detention. However, currently he suffers from various health problems.
Adeel reported that since his detention in Guantánamo, he has been suffering from back and knee pain; he explained that his knee was swollen, and he was given anti-inflammatory drugs in Guantánamo. Currently, when he stands up, he hears a cracking sound in his knee that he attributed to not having been allowed to move in Bagram, to having been kept in painful stress positions on the floor in Guantánamo, to having been forced to sleep on a metal bed, and having been kept in “iron cages” with cold air conditioning. He reported that after his release, he could not move and continues to suffer from pain in his hip joint and back.
Adeel reported that in Guantánamo, he was diagnosed with tuberculosis and was given isoniazid and vitamin B6. According to Adeel, he recovered just before his release. Since his detention in Bagram, he reported having suffered from constipation; he can only go to the toilet two to three times a week. He stated that he often had gastric pain for which he was sometimes given drugs like “Librax.” He has had stomach problems with epigastric pain, which is associated with a bad taste in his mouth in the morning and exacerbated when he eats butter, oil or spicy food.
While in Guantánamo, he got fungus on his feet and on the axillary (armpit) area and attributes this to the fact that the detainees did not have personal overalls and their clothes would get mixed up when they would return from the laundry. In the last two years of detention his skin turned dark on the left abdominal region. He used antifungal medication, which did not help.
Since his early days in Guantánamo, Adeel reported sometimes having ear pains that, despite his requests, were not examined; nor was he given any medication.
Adeel reported that while in detention, twelve of his teeth began to rot. He attributed this to not having a toothbrush and only using “bad toothpaste.” He did not seek to see a dentist since he feared that the dentists would remove his teeth instead of repairing them.
Assessment of Physical Evidence
The physical examination revealed several findings consistent with Adeel’s allegations of torture. For example, the diagnoses of otitis externae (inflammation of the outer ear canal) and atrophic tympanic membrane (thinning of the eardrum) are consistent with his allegation of eardrum perforation as a result of beatings with subsequent secondary infection. The neurological examination of Adeel showed no neurological and pathological signs. Constipation can occur secondary to stress conditions and can result from inadequate intake of fluids and food and restrictions on mobility. The chronic constipation Adeel reported also may represent a psychosomatic manifestation of several forced anal cavity searches and a physical response to the detention conditions he reported.
Adeel had demonstrated gingival (gum) recession and absence of teeth which is highly consistent with Adeel’s report of poor hygiene and health conditions in detention. Adeel had demonstrated vertebral abnormalities. Spondyloarthrosis51 and discopathy52 at the level of the second and third lumbar (L2-L3) vertebrae is consistent with his reports of long-lasting restriction of movements and physical trauma during detention. He experienced pain in right knee movements which is consistent with restriction of movements and reported knee trauma. However a dermatological expert opinion is needed to determine whether the darkening of the skin in the abdominal region is an after-effect of some kind of chronic intoxication by chemicals used for sanitary purposes or other substances applied during detention or post-inflammatory change after a fungal infection. Moreover, an orthopedic expert opinion and bone scan would aid in the detection of signs of non-visible soft tissue and bone injuries by beatings.
Medical Tests: Laboratory tests showed a normal blood count and normal blood chemistry results with the exception of an elevated hepatitis B antibody level (24 mU/ml) indicating exposure to the hepatitis B virus. Because Adeel does not remember any vaccination of hepatitis B, it may be the result of a past hepatitis B infection.
Assessment of Psychological Evidence
Adeel reported that there is no history of psychiatric disorders in his family. He described feeling helpless, desperate, devastated, destroyed and very confused during his detention. Recalling his darkest moments while in detention, Adeel remembered thinking that “Satan” tempted him to commit suicide. But he said he adhered to Islamic rules. He stated that he was in constant fear, felt threatened and was always on the alert and under stress. He had palpitations and sweated profusely. He sometimes heard people speaking about him and then realized that he had only imagined it. He realized that he was hallucinating, which made him afraid that he was going “crazy.”
Adeel stated that he currently feels that this traumatic experience has transformed him into a different person, and he no longer has a strong will: “I have lost all my life,” he noted. He reported feeling lonely, isolated and abandoned. He stated that he does not have a job and lives far from his family or anyone with whom he can communicate and share his problems. He stated that he only lives with a small subsidy. He mentioned that he misses his family terribly and that he is afraid of the future. “I feel like I am in a big prison and still in isolation.”
He reported having nightmares of Guantánamo that force him to wake up in the middle of the night, and not being able to go back to sleep because he ponders his misery. He reported starting to panic when somebody walks behind him and that he often feels people are looking at him, which makes him think that he is not normal. He stated that he is nervous and he gets irritated about minor problems. Adeel reported that he sometimes suffers from blackouts and he has lost some of his memory capacity. He cannot remember the Koran very well, and he has no desire to read like he did before.
Adeel reported that he generally mistrusts and is afraid of people unlike before. He stated that he avoids making friends and does not want to talk to anybody. He said that his view of the world has changed for the worse. He is haunted by the bad memories from Guantánamo every day, and he avoids people with uniforms when he is in the public. He reported that he avoids thinking about his situation in order not to bring back bad memories. However, his solitude and overall situation make it difficult for him to distract himself from thinking about these traumatic experiences.
Psychological Tests:53 On the self-report measures administered, Adeel reported numerous symptoms of PTSD, anxiety, somatization, and depression. Adeel’s responses to the Dot Counting Test, a clinician-administered test of symptom exaggeration, indicated that he responded honestly with no evidence of deliberate exaggeration.
Analysis and Conclusions
Adeel demonstrated historical, physical, and psychological evidence that strongly supports his allegations of ill-treatment.
Adeel suffers from chronic constipation. This symptom may be an after-effect of forced body cavity searches and physical response to detention conditions given the level of psychological trauma associated with his experiences. Evidence of eardrum perforation and chronic outer-ear infection is consistent with Adeel’s history of beatings to the head. He suffers from inflammation of the gums and loss of teeth likely due to poor hygiene in detention. He was diagnosed with Spondyloarthrosis and discopathy at the level of second and third lumber (L2-L3) vertebrae and suffers from chronic pain of his knees and joints that is consistent with Adeel’s history of restricted movements, prolonged exposure to cold temperatures and being shackled in painful positions for long periods of time. He also suffers from chronic gastritis. Considering that there is a pre-detention history of duodenal ulcer, his gastric complaints are most likely due to a preexisting ulcer disease and likely have been aggravated and become chronic because of detention.
Based on the self-report, Adeel suffered from transitory psychotic episodes that were likely due to longterm isolation in Guantánamo and the effects of the medications he received. Presently there are no signs of psychosis. The results of psychological testing and the clinical findings support the presence of several psychiatric diagnoses including major depressive episode and post-traumatic stress disorder. He suffers from intrusions, avoidance behavior and hyperarousal. He is constantly haunted by the memories of trauma; he avoids triggers that remind him of Guantánamo; and he has sleeping problems. He suffers from irritability, startle response, inability to concentrate, and memory loss. He is hypervigilant and has lost trust in people. All these symptoms confirm the diagnosis of PTSD. Additionally he feels hopeless and sees no future for himself. He has lost his energy and he isolates himself from people, all symptoms that support the diagnosis of depression.
Adeel’s condition is particularly aggravated by the fact that he lives in social isolation, is unemployed, below the poverty line, and cut off from his family. He has virtually no opportunity for building a new life or finding a job. In addition, he does not have access to health care and psychological support services. Accordingly he sees his current life as an extension of his detention in Guantánamo.
In conclusion, the physical and psychological evidence demonstrate that Adeel is suffering from considerable physical and psychological pain as a result of his arrest, incarceration and ill-treatment.
Notes
49. Adeel’s medical evaluation was conducted by Onder Ozkalipci, MD and Christian Pross, MD.
50. He was shown the color codes at the below internet link for describing the color range of the drinking water: http://www.pitt.edu/~nisg/cis/web/cgi/rgb.html. He responded that the color of the water changed between the color codes: 255 250 240 up to 255 218 185. Every time when they filtered the water with toilet paper it was still a brown color. When asked whether he or other prisoners had suffered from gastroenteritis or whether a gastroenteritis epidemic occurred in the camp, he said no. He remembered the water smelled of chlorine.
51. A complication from degeneration of the vertebra and intervertebral disks. Osteophytes, or bone spurs, form about the degenerating tissue which may, in turn, compress spinal nerves.
52. Refers to disease of the intervertebral disks.
53. 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).
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