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Medical and Psychiatric Evaluation of Ahmed Zaid Salem Zuhair

On April 28, 2009, Dr. Emily Keram sent to Judge Emmet Sullivan a report of the medical and psychiatric evaluation she performed on Guantanamo prisoner Ahmed Zaid Salem Zuhair (ISN 669). The report was requested by Judge Sullivan with regards to the case of Zuhair vs. Obama, et al. (Civ. No. 08-0864 EGS), tried in the United States District Court for the District of Columbia. The evaluation on which the report was based took place in the Guantanamo Naval Base, from January 17-24, 2009. CSHRA has selected some of the passages of that report and transcribed them below. The full report can be found here.


•  Mr. Zuhair began a hunger strike in April 2005 to protest "the assault against our religion." […] From the time of his first enteral feedings until January 2006 Mr. Zuhair was administered feedings in the Detention Hospital while in two or four point restraints in a hospital bed. Mr. Zuhair described the conditions of enteral feedings in the hospital as "good". Feeding tubes were small bore (12 French) and where placed by physicians. Feeding tubes were coated with a topical anesthetic and lubricant prior to insertion. He was provided with honey, lozenges, and cough syrup for feeding tube discomfort. Tubes were left in place for approximately 20 days, obviating the need for daily insertion and removal.

In January 2006 restraint chairs were introduced and detainees receiving enteral feedings were moved from the Detention Hospital to dedicated residential "feeding blocks". Mr. Zuhair received enteral feedings in a restraint chair from that time until his admission to the Detention Hospital on February 9, 2009 […]. Feeding tube insertion was initially done by Corpsmen and is now done by nurses. Feeding tube placement was more forceful when done by Corpsmen. Larger bore (14 to 16 French) tubes were used then and caused more discomfort. Topical anesthesia was used for the first month only. […]

When the restraint chairs were first introduced Mr. Zuhair was kept in the restraint chair for two hours after feeding ended. His requests to use the bathroom were refused. He soiled himself with urine and feces. Guards started putting diapers on Mr. Zuhair, refusing to allow him to do this himself. Some detainees ended their hunger strike. Mr. Zuhair was once kept in a restraint chair for six hours, exceeding the two hour maximum time limit recommended for the detainee's safety. When the restraint chairs were first introduced Mr. Zuhair was refused a change of clothing when he returned to his cell, despite being covered with vomit, urine, and feces. The temperature on the residential block was cold. Mr. Zuhair expressed his conviction that the restraint chairs were introduced as a means of punishing hunger striking detainees and forcing them to end their hunger strikes [Keram Report, pp. 9-10].

• On the rare occasions that he refused to leave his cell for enteral feedings, the FCE [or Forced Cell Extraction] team entered his cell […] FCE team members carried him to the restraint chair [Keram Report, p. 10]

• Insertion of the tube "hurts" at times […] Mr. Zuhair stated that he experienced pain and discomfort from the restraint chair and the enteral feeding process. He was diagnosed with coccydynia (tailbone pain) and hemorrhoids. The restraint chair kept the occupant's back reclined at an angle. The position of his body in the restraint chair caused and exacerbated coccyx and hemorrhoid pain […] The restraints chafed at times […] Mr. Zuhair stated that some guards fastened the restraints too tightly and would intentionally bump his restraint chair while he was being fed, increasing his discomfort. The nurse was sometimes rough when inserting the tube, and did not respond to his complaints of discomfort [Keram Report, p. 11].

• Mr. Zuhair stated that the use of the restraint chair was degrading. "The treatment of animals is better. I feel as though I'm not being treated like a person." […] "They treat me like a criminal. It takes away from my honor, it reduced my dignity" […] "I'm a person. I have my honor, my dignity, my humanity" […] The chair takes away my free will. It does not kill my sould or my spirit. I love life, but they've taken my fee will away from me. They killed my freedom [through indefinite detention] and now I have lost my free will." [Keram Report, p. 11].

• Guard staff denied harassing Mr. Zuhair during enteral feedings. They specifically denied bumping his chair. [Keram Report, p. 13].

• Mr. Zuhair has been on hunger strike since April 2005 [now being April 2009] [Keram Report, p. 15].

• Mr. Zuhair maintained that when the hunger strike first started routine medical care was withheld when he refused to eat. For example, he was not given Tylenol for headache. He stated that he was told that if he ate, his medical concerns would be addressed [Keram Report, p. 20].

• [S]ome physician orders are never followed. A good example of this is the fact that a hemorrhoid pillow was ordered for him, but he never received it [Keram Report, p. 21].

• Mr. Zuhair reported four events in which he experienced events that involved actual or threatened death, serious injury, or threat  to his physical integrity, to which he responded with intense fear.  The first occurred just after being taken into custody in Pakistan when he was beaten over a twenty-four hour period. He could not breathe at times and he thought he was going to die, "I wished they would kill me the pain was so great." The second occurred in American custody, midair on the plane from Bagram to Kandahar. The detainees were bound and blindfolded. The door of the plane was opened and he heard someone shout in Arabic, "They're throwing me from the plane! They're throwing me from the plane." Guards grabbed and beat him. Zuhair thought he would be the next to be thrown from the plane. The next traumatic event occurred in American custody in Bagram during an interrogation. He was threatened with being turned over to the Egyptians who would rape him if he did not admit to being involved in the Cole bombing. He felt this was a credible threat because he had heard the Egyptians employed that form of physical abuse. The fourth and last event needs to be understood in the context of his faith and culture. He reported being traumatized by body cavity searches, which he perceived as a threat to his physical integrity [Keram Report, 24-25].

Get the full report here