The Role of Culture in Torture and its Absence in Guantanamo’s Medical Care System (2023)

by Yumna Rizvi

April 25, 2023

Late last month, the United Nations Human Rights Council made public a communication by seven U.N. experts criticizing the U.S. government on the state of medical care for detainees at Guantanamo Bay. The communication, filed on January 11 (the 21st anniversary of the opening of Guantanamo Bay), highlighted the case of Abd Al-Hadi Al-Iraqi (Nashwan al-Tamir), a detainee in his 60s, who is suffering from a degenerative spinal disease, has undergone six back and neck surgeries at Guantanamo since 2017, and whose health continues to deteriorate.

The experts found “systematic shortcomings in medical expertise, equipment, treatment and accommodations at the Guantánamo Bay detention facility and naval station.” The communication also served as a reminder of the government’s responsibility to provide “adequate redress and reparation for any human rights abuse and other international law violations committed in the delivery of detainee healthcare.”

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Disclosure of the experts’ communication came on the heels of an article in Just Security by Mort Halperin and Steve Xenakis (the latter is a retired brigadier general and psychiatrist) explaining the legal and moral imperative of providing torture rehabilitation – and adequate medical care more generally – to the men still detained at Guantanamo. This article highlights an aspect of the problem that arose at a recent military commission hearing: the closely tied roles of trauma and culture, and the astonishing hypocrisy with which Guantanamo’s medical care system approaches them. In short, culturally competent medical care, including to the extent possible care provided by independent medical experts of the detainees’ nationalities, is needed at Guantanamo now.

Trauma and Culture in Guantanamo’s Medical Care System

In February, two medical expert witnesses testified in the latest pre-trial hearings in the USS Cole bombing case: Dr. Sondra Crosby, an expert on torture and trauma, and Guantanamo’s senior medical officer (SMO). (Note that the SMO is different from the Chief Medical Officer, a position Congress established several years ago that reports outside the Guantanamo chain of command.)

Dr. Crosby testified about torture methods that Abd al-Rahim al-Nashiri, the defendant, was subjected to while in CIA custody from 2002 to 2006, with a particular focus on “rectal feeding” in 2004. Carol Rosenberg at the New York Times called it the “most detailed public account of the procedure, from a medical perspective” to date.

The SMO followed. He testified he is currently treating Mr. Nashiri for “active issues,” and was informed, when taking on his role, that his patients were subjected to “CIA enhanced interrogation.” However, he was unaware of the methods Mr. Nashiri was subjected to because after reviewing Mr. Nashiri’s medical history, he found no records from when Mr. Nashiri was in CIA detention, and “no evidence that anyone on the Guantanamo medical staff took a trauma or torture history of him” when he arrived there in 2006.

Failure to ask about and document such a history is a clear, and now longstanding, violation of the applicable standard of care, born of continued secrecy around CIA torture, that cuts across the detainee population. To prepare his testimony, the SMO reviewed external sources such as the 2014 Senate Torture report, an ICRC report, and previous statements, including Dr. Crosby’s.

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His testimony was filled with other admissions that were at once significant, ironic, and outrageous, including that he was not trained in treating torture survivors, and “he received no specific cultural sensitivity training for this assignment ‘on how to treat Muslim men.’”

The SMO’s testimony was significant because no government official has publicly confirmed that culturally competent medical care, recommended by independent medical experts as required for adequate treatment, is not available at the detention center. It was ironic and outrageous because, in the early stages of the so-called War on Terror, the U.S. government used knowledge of Islam and cultural norms to torture and otherwise torment Muslims, but in the over 20 years since apparently has not considered it relevant to their medical care.

It’s commonly known that religious beliefs and cultural norms were weaponized against Muslim men in Abu Ghraib, Bagram, and Guantanamo. A list of authorized tactics by then Secretary of Defense Donald Rumsfeld included removal of religious items and forced shaving of facial hair. Qur’ans were burned and defaced. Olive oil labeled a “culturally sensitive material,” was used to lubricate tubes for force-feeding. Underpinning these specific torture and cruel treatment techniques, Islamophobia was institutionalized — courses at military schools taught officers Islam is their enemy. A 2012 military investigation into the burning of Qur’ans in Bagram found “troops were exposed only to about an hour-long PowerPoint presentation about Islam,” prior to deployment to Afghanistan.

On more than one occasion, independent medical experts have emphasized the importance of culturally competent care for treatment of detainees. It is also referenced in Article 30 of the Third Geneva Convention, to which the United States is a party, which states, “prisoners of war shall have the attention, preferably, of medical personnel of the Power on which they depend and, if possible, of their nationality.

The ICRC commentary to Article 30 explains that “medical personnel of the same nationality… may … increase the availability, and potentially also the quality, of medical services…” as they would “have expertise in the treatment of endemic diseases unfamiliar to the Detaining Power or where being of the same cultural background may help to manage prisoners’ mental health conditions.” It also notes that “medical personnel of the same nationality as the prisoners may help create trust” between the detaining Power and prisoners. Given the role of U.S. military medical personnel in the torture of many detainees at Guantanamo, and the trust deficit it created, it would be wise for the government to heed this recommendation.

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In 2009, three behavioral health professionals in Guantanamo’s Joint Medical Group published an article in which they acknowledged how difficult it is to understand and manage health conditions without cultural context. “[T]he acceptance of Western diagnostic formulation among the detainees is low,” they wrote, “and its appropriateness debatable. At times a patient’s presentation is inconsistent with any formulation using the traditional diagnostic criteria found within the Diagnostic and Statistical Manual of Mental Disorders-IV… and some individuals appear unable or unwilling to accept Western terminology.” For example, certain mental illnesses – as understood by detainees – are caused by ‘jinns,’ or supernatural beings and spirits, which “in the Muslim imagination… occupy a shadow world.” The authors explained that:

“mental health providers have had to learn a great deal about the various cultures the detainees come from… [The providers] have access to an Imam and cultural advisor for consultation, are provided mentoring as needed from mental health providers who have already served in GTMO and incorporate culturally specific training into staff education.”

All of that may be true as far as it goes, but none of it meaningfully addresses the problem. Neither the Imam nor the cultural advisor are qualified medical providers and detainees come from many more cultures than the two could represent. Moreover, information the two would need to provide adequate advice and consultation – specifically about detainees’ torture – was, and still is, mostly classified.

Even if these limitations were somehow resolved, “access” to the Imam and cultural advisor doesn’t mean that military medical professionals would actually get from them the information that they need. This is, to some extent, a structural problem. The Imam and cultural advisors (like Guantanamo’s medical staff) have to balance “dual loyalties” to their employer and to their profession, the latter as it relates in particular to moral, ethical and humane treatment. When the employer is engaged in extra-legal detention of men it long-branded “the worst of the worst,” this can be a near impossible line to walk. For example, former Imam Captain James Yee believes that his legal troubles, which included criminal charges of espionage, spying, and aiding the enemy– stemmed from advocating for humane treatment of detainees. All criminal charges against Yee were later dropped due to lack of evidence; he was reprimanded on minor non-criminal charges and honorably discharged. On the other end of the spectrum, long-time cultural advisor of Middle Eastern descent, Zak Ghuneim, accused detainees of participating in hunger strikes to “discredit the US.” In 2007, he called “complaints of prisoner mistreatment ‘baloney.’”

And even if there was cultural training and staff education in 2009, the current SMO’s testimony that he did not receive any cultural sensitivity training means there is clear problem at Guantanamo today.

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How to Solve the Problem of Culturally Competent Medical Care

The UN experts recommended the U.S. government “ensure a human-rights-based and gender- and culturally sensitive approach to the provision of health care services to all detainees…” They further offered technical support to assure compliance with international law.

The Biden administration needs to understand that there have been – and continue to be – real, human consequences of the decision not to call torture what it is. But it is also not too late to begin to correct the failings of the Bush, Obama, and Trump administrations before it. The Department of Defense, working with both interagency experts on culturally competent medical care and – to the extent possible – independent medical experts of the detainees’ nationalities, can begin to provide culturally appropriate medical care at Guantanamo now, including for those whose cultural beliefs were used as implements of torture. Medical staff can, and must, take medical histories that include the torture and other traumas detainees were subjected to, and can do so in culturally appropriate ways that inform ongoing and future treatment.

Of course, while it is necessary and required, just culturally competent medical care is not sufficient to adequately address the U.S. government’s long-term dehumanization of the men at Guantanamo. As Xenakis and Halperin explained, the government is also obligated to provide torture rehabilitation. And General comment No. 3 on the implementation of article 14 of the Convention against Torture requires that effective rehabilitation services and programs established by State parties consider a victim’s culture. It specifically provides that “culturally sensitive collective reparation measures shall be available for groups with shared identity.”

The participation of independent medical experts is pivotal in this process. Their role should not be minimal, it is the only solution to the quagmire the government has created by involving military medical personnel in the torture and trauma of detainees and weaponizing culture. U.S. military medics who are Arab, Middle Eastern, Muslim, and South Asian, while helpful, may face challenges in building trust and navigating dual loyalties.

All of this must be done with the sense of urgency appropriate to the task – a failure to do so only lends credence to the view that dehumanization, racial and cultural injustice, and willful blindness of past wrongs are acceptable to the Biden administration and the U.S. military.

(Video) Exclusive Tour Of Guantanamo Bay's Camp X-Ray - Full Documentary

IMAGE: A physical therapy room for older detainees is seen at the US Guantanamo Naval Base on October 16, 2018, in Guantanamo Base, Cuba. (SYLVIE LANTEAUME/AFP via Getty Images)

Filed under:

Abu Ghraib, Biden administration, CIA, Convention Against Torture, detainee treatment, Detention, Guantanamo, International Law, Islam, Medical Personnel, Racial Justice, Third Geneva Convention, torture, United Nations Human Rights Council, United States


How were prisoners tortured in Guantanamo Bay? ›

Former detainees have described being waterboarded, deprived of sleep, subjected to constant blasting music and freezing temperatures, or forced into stress positions.

Does Guantánamo violate habeas corpus or are detainees provided a form of habeas corpus? ›

However, the most recent case law development has been in the US Supreme Court case Boumediene v. Bush where it was established Guantanamo detainees have a right to habeas corpus and are able to bring their petitions to U.S courts.

What is the controversy with Guantanamo Bay? ›

Current and former detainees have reported abuse and torture, which the Bush administration denied. In a 2005 Amnesty International report, the facility was called the "Gulag of our times." In 2006, the United Nations unsuccessfully demanded that Guantanamo Bay detention camp be closed.

Are there still prisoners at Guantanamo Bay? ›

As of February 2023, 31 detainees remain at Guantanamo Bay. This list of Guantánamo prisoners has the known identities of prisoners at the Guantanamo Bay detention camp in Cuba, but is compiled from various sources and is incomplete.

How were the prisoners in Guantanamo Bay treated? ›

Over the years, many detainees have claimed that they were detained unlawfully, denied due process, and subjected to grave physical and psychological abuses—some amounting to torture—by their American captors.

What human rights are being violated in Guantanamo Bay? ›

Violations of international law at Guantánamo include illegal and indefinite detention, torture, inhumane conditions, unfair trials (military commissions), and many more. These human rights violations, however, remain unpunished or remedied.

What type of rights do you have under habeas corpus? ›

The "Great Writ" of habeas corpus is a fundamental right in the Constitution that protects against unlawful and indefinite imprisonment. Translated from Latin it means "show me the body." Habeas corpus has historically been an important instrument to safeguard individual freedom against arbitrary executive power.

Does the Constitution apply to Guantanamo? ›

The majority, however, also found that Guantanamo detainees do not enjoy protections under the Due Process Clause of the Constitution, as they are non- citizens held outside the United States and lack significant ties to the country.

How does habeas corpus protect a prisoner? ›

A writ of habeas corpus is used to bring a prisoner or other detainee (e.g. institutionalized mental patient) before the court to determine if the person's imprisonment or detention is lawful. A habeas petition proceeds as a civil action against the State agent (usually a warden) who holds the defendant in custody.

Why does the US want Guantanamo Bay? ›

Guantanamo Bay interested U.S military planners due to its geographical location in the Caribbean. It became a strategic location in defending the Panama Canal and the southern US coast. It was also a natural haven for naval vessels in the region.

What are the inhumane conditions in Guantanamo Bay? ›

“Guantanamo Bay is a site of unparalleled notoriety, defined by the systematic use of torture, and other cruel, inhuman or degrading treatment against hundreds of men brought to the site and deprived of their most fundamental rights.”

Why is Guantanamo Bay necessary? ›

All things considered, the detention facility at Guantanamo Bay has played an invaluable role in the war against terrorists by keeping them off the battlefield and allowing for lawful interrogations.

Who did Biden release from Guantanamo Bay? ›

This week's release of 48-year-old Ghassan Abdullah al-Sharbi to Saudi Arabia — and last month's release of two detainees to Pakistan and one to Belize — indicates that the Biden administration is accelerating its efforts to close Guantánamo, or at least reduce its inmate population to only those facing criminal ...

How many people are left in Guantánamo? ›

Today, 32 detainees remain at Guantanamo Bay: 18 are eligible for transfer; 3 are eligible for a Periodic Review Board; 9 are involved in the military commissions process; and 2 remaining detainees have been convicted in military commissions.

Who was just released from Guantanamo Bay? ›

Never charged with a crime, Ghassan Al Sharbi, 48, returns to Saudi Arabia after being held for 21 years at Guantanamo.

Does Guantánamo Bay have the death penalty? ›

The military also has jurisdiction over military commissions, which are tribunals convened to try people accused of unlawful conduct associated with war, such as those established in Guantánamo Bay after the September 11, 2001 attacks. No one has been sentenced to death under these commissions.

How much does Guantánamo Bay cost? ›

According to reports, the prison costs over $500 million per year to operate, at a staggering annual cost of $13 million per prisoner, over 350 times the cost of incarcerating a prisoner at a maximum-security facility in the United States.

Can you visit Guantánamo Bay? ›

All non-active duty personnel must have a current passport to get on NSGB. You must obtain passports (for the entire family), before arriving. Visitors will need an "Area Clearance" before they can be granted entry to NSGB.

Does Guantanamo Bay violate the 8th Amendment? ›

Does this violate the 8th amendment? Yes, it does. In response to confrontations of the prisoners at Guantanamo Bay and human rights activists, the US Supreme Court sent a series of rulings that blocked The Bush administration's efforts to try prisoners at the base.

What is an example of habeas corpus in real life? ›

An example of a petition for habeas corpus in the U.S. occurred in the 2009 case Knowles v. Mirzayance. Mirzayance had been accused of murder and had pled not guilty and not guilty by reason of insanity (NGI); however, his legal counsel dissuaded him from pursuing the NGI plea, and he was found guilty.

Is habeas corpus good or bad? ›

The Court observed that"[t]he writ of habeas corpus is one of the centerpieces of our liberties. 'But the writ has potentialities for evil as well as for good. Abuse of the writ may undermine the orderly administration of justice and therefore weaken the forces of authority that are essential for civilization.

What is the success rate of habeas corpus? ›

It found that 3.2 percent of the petitions were granted in whole or in part, and only l. 8 percent resulted in any type of release of the petitioner. Successful habeas corpus claims in most cases do not produce a prisoner's release, but rather a requirement for further judicial review.

What country would you be in if you are in Guantanamo? ›

Since the first detainees arrived in 2002, the United States' detention facility at Guantanamo Bay, Cuba, has housed a total of 779 detainees. There are currently 80 detainees remaining in Guantanamo Bay.

What gave the United States rights to intervene in Cuba and the use of Guantánamo Bay? ›

The Platt Amendment stipulated the conditions for U.S. intervention in Cuban affairs and permitted the United States to lease or buy lands for the purpose of establishing naval bases (the main one was Guantánamo Bay) and coaling stations in Cuba.

Does Guantánamo Bay follow the Geneva Convention? ›

Although all of the Guantanamo Bay detainees are enti- tled to humane treatment under the broad provisions of the Geneva Conventions and the more specific provisions of international human rights treaties, those entitled to POW sta- tus are guaranteed further protections.

What is the main purpose of the habeas corpus? ›

A writ of habeas corpus orders the custodian of an individual in custody to produce the individual before the court to make an inquiry concerning his or her detention, to appear for prosecution (ad prosequendum) or to appear to testify (ad testificandum).

What did habeas corpus give every prisoner? ›

Habeas corpus is a Latin phrase meaning “produce the body.” By means of the writ of habeas corpus a court may order the state to “produce the body,” or hand over a prisoner so that it might review the legality of the prisoner's detention.

What actions are habeas corpus? ›

Federal habeas corpus is a procedure under which a federal court may review the legality of an individual's incarceration. It is most often the stage of the criminal appellate process that follows direct appeal and any available state collateral review.

Is Guantanamo Bay considered U.S. soil? ›

And while there has been a continuous American presence at Guantánamo Bay since U.S. forces took it in a Spanish-American war battle in 1898, it's technically leased territory.

Who is in charge of Guantanamo Bay? ›

JTF-GTMO falls under US Southern Command. Since January 2002 the command has operated the Guantanamo Bay detention camps Camp X-Ray and its successors Camp Delta, Camp V, and Camp Echo, where detained prisoners are held who have been captured in the war in Afghanistan and elsewhere since the September 11, 2001 attacks.

Are U.S. citizens allowed to travel to Cuba? ›

It's perfectly legal for Americans to travel to Cuba, except for explicit tourism purposes. However, you will need to meet some requirements. Specifically, you need a Cuban Tourist Card (a.k.a Cuban Visa), travel insurance, and a self-certification under one of the 12 travel categories of authorized travel to Cuba.

Why is Guantánamo Bay not closed? ›

He was able to decrease the prison's population but faced legal challenges. Ultimately, no president has been able to close Guantánamo because once something is created outside the law, it's almost impossible to bring it back inside the law.

What happened in the Guantánamo cases? ›

From 2004 to 2008, three men who were held as detainees at Guantánamo Bay won Supreme Court cases that came to shape the military's authority to detain men at the U.S. Navy base in Cuba. Prisoners there now have access to lawyers, a right denied them for nearly three years.

Who owns the land at Guantanamo Bay? ›

Guantanamo Bay Naval Base
Naval Station Guantanamo Bay
TypeUnited States military base
Site information
OwnerGovernment of Cuba (de jure) U.S. federal government (de facto)
OperatorUnited States Navy
19 more rows

When did American troops land in Guantanamo Bay Cuba? ›

On June 10, 1898, U.S. Marines landed at Guantánamo Bay.

How many Muslims are in Guantánamo? ›

Since 2002, 779 Muslim men and boys have been held at Guantánamo, nearly all of them without charge or trial. Today, 39 men remain indefinitely detained there, and 27 of them have never even been charged with any crime. Fourteen of those 27 have been cleared for transfer or release, some for years.

Who is the longest detainee in Guantánamo? ›

Businessman Saifullah Paracha, who was arrested in 2003 and accused of financing al-Qaeda, was never charged like most prisoners.

Did anyone escape Guantanamo Bay? ›

Answer and Explanation: Yes, people have escaped Guantanamo Bay naval base. Though these escapes were prior to the base housing a prison, which was established in 2002, and since the establishment of the prison there have been no escapes.

Are the 2 brothers released from Guantanamo Bay? ›

ISLAMABAD (AP) — Two Pakistani brothers held by the United States at Guantanamo Bay detention facility for two decades were freed and returned home on Friday to be reunited with their families, officials said.

Did Guantánamo prisoner get released to Belize? ›

The Department of Defense announced today the transfer of Majid Khan from the detention facility at Guantanamo Bay to Belize. Majid Khan pled guilty before a Military Commission in February 2012.

What happened to the female soldier at Abu Ghraib? ›

England after she was sentenced to three years for prisoner abuse at Abu Ghraib.

Were people killed in Guantanamo Bay? ›

Since Guantanamo opened, nine prisoners have died — two from natural causes, and seven in apparent suicides.

What was the reason given by America for imprisoning people at Guantanamo Bay? ›

The reason given by America for imprisoning people at Guantanamo Bay is that America considered them enemies and linked them to the attack on New York on 11th September 2001. The United States maintains a military detention facility at Guantanamo Bay.

What happened in the Guantanamo cases? ›

From 2004 to 2008, three men who were held as detainees at Guantánamo Bay won Supreme Court cases that came to shape the military's authority to detain men at the U.S. Navy base in Cuba. Prisoners there now have access to lawyers, a right denied them for nearly three years.

What happened to the torturers at Abu Ghraib? ›

In the United States, 11 soldiers were eventually convicted in 2006 of crimes at Abu Ghraib. Lynndie England, one of the soldiers who Majli says abused him, was sentenced to three years in prison for charges including committing an indecent act and maltreating detainees.

Who was the woman behind the camera at Abu Ghraib? ›

Sabrina D. Harman (born January 5, 1978) is an American former soldier who was court-martialed by the United States Army for prisoner abuse after the 2003–2004 Abu Ghraib prisoner abuse scandal.

What was the inhumane treatment at Abu Ghraib? ›

Sleep deprivation and forced standing were the most common thing that most prisoners were suffering. They were handcuffed to the cell walls in a position in which they were standing, their hands were placed down between their legs, and then their hands were handcuffed back behind them, which ...

How many people are still being held in Guantanamo Bay? ›

Today, 32 detainees remain at Guantanamo Bay: 18 are eligible for transfer; 3 are eligible for a Periodic Review Board; 9 are involved in the military commissions process; and 2 remaining detainees have been convicted in military commissions.

Why is Guantánamo allowed? ›

The 1903 Lease Agreement gave Cuba “ultimate sovereignty” and the United States “complete jurisdiction and control” over the 45 square miles that would become the U.S. naval base in Guantánamo Bay. This set up a clear legal contradiction.

What is the importance of Guantanamo Bay Cuba? ›

Often called “Gitmo” by naval personnel assigned there, it is used primarily as a U.S. fleet training base in the Caribbean Sea. From 2002 it served as an internment facility for Muslim militants following the U.S. campaigns in Afghanistan and Iraq.

What was the purpose of Guantanamo Bay? ›

Constructed in stages starting in 2002, the Guantánamo Bay detention camp (often called Gitmo, which is also a name for the naval base) was used to house Muslim militants and suspected terrorists captured by U.S. forces in Afghanistan, Iraq, and elsewhere (see also Iraq War).

Was Guantanamo Bay never charged? ›

The vast majority of those men were never charged with any crimes. Although hundreds were released over the years, 35 men remain at Guantánamo today, at the astronomical cost of $540 million per year. That makes Guantánamo the most expensive detention facility in the world.

How much does Guantanamo Bay cost? ›

According to reports, the prison costs over $500 million per year to operate, at a staggering annual cost of $13 million per prisoner, over 350 times the cost of incarcerating a prisoner at a maximum-security facility in the United States.

Can you visit Guantanamo Bay? ›

All non-active duty personnel must have a current passport to get on NSGB. You must obtain passports (for the entire family), before arriving. Visitors will need an "Area Clearance" before they can be granted entry to NSGB.


1. Guantanamo and the legal battle against torture (HCRI/MILC public lecture)
2. Guantánamo Diary: An Evening of Reading and Conversation
(PEN America)
3. Guantanamo prison 20 years on: Can it ever be closed? | DW News
(DW News)
4. What's Actually Happening Inside Guantanamo: Blacked Out Bay
(VICE News)
5. Yasiin Bey (aka Mos Def) force fed under standard Guantánamo Bay procedure
(The Guardian)
6. Reclaiming the Rule of Law: Guantánamo’s Forever Prisoners and the Fate of Liberal Democracy
(Georgetown Law)
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