TD Blog Interview with Dr. Steven Miles

Dr. Steven Miles is the author of Oath Betrayed: Torture, Medical Complicity and the War on Terror, a scathing examination of the failings of members of the medical profession serving in the military with respect to treatment of prisoners held by American forces in the war on terror, demonstrating such abuses as medical personnel participating in coervice interrogations if not outright torture (including using prisoners’ own medical records against them), preparing misleading, if not outright falsifying, medical records including death certificates, and failing to advocate for prisoners being placed in dangerous situations (e.g., such as under weapons fire, or in dangerously unsanitary conditions). Dr. Miles expanded on an article on this subject he published in the Lancet in 2004, relying on an examination of declassified, publicly available documents from our government and military.
Dr. Miles is a practicing physician, bioethicist, and professor of medicine at the University of Minnesota. He has served as a chief medical officer in a Cambodian refugee camp, worked on AIDS prevention in Sudan, tsunami relief in Indonesia, worked with the research committee of the Center for Victims of Torture, and has been honored wth the Distinguished Service Award of the American Society of Bioethics and Humanities, and was named the 2004 “Minnesotan of the Year.”
On September 15, 2006, I had the privilege of interviewing Dr. Miles by e-mail exchange.
The Talking Dog: Where were you on September 11, 2001?
Steven Miles: I was flying from Minneapolis to Florida. My plane was diverted to Nashville. When I stepped out of the plane, I watched the towers go down and realized that the airports would be closed indefinitely so I stayed in Nashville for a couple days before taking a Greyhound home.
The Talking Dog: Your book identifies three main failings of medical professionals participating as members of the military or rendering assistance thereto, i.e. (1) participating in coercive interrogations (including using prisoners’ own medical records against them); (2) failing to timely ensure findings of death reliably communicated (and failing to adequately document cases of abuse and otherwise maintain full medical records); and (3) failing to advocate for even minimal resources necessary for mental health care, sanitation, TB treatment, shelter from weapons fire or often provision of treatment. You’ve also indicated that medical societies and state licensing boards have generally taken limited action. Certainly, the abuse of medical records, or failure to keep and maintain proper medical records alone, without any other misconduct, would be grounds for professional discipline against any physicians or licensed nurses involved in New York, where I practice law. Are you aware of any state licensing boards taking professional disciplinary action against any medical personnel associated with the military’s (or other governmental agencies’) conduct of the “war on terror”?
Steven Miles: A complaint for unprofessional conduct was filed with the California Medical Board against a Guantanamo physician. The Board refused to process the complaint. This kind of accountability is important. I get asked this question a lot by lawyers who, by the way have done nothing with regard to the lawyers who wrote the policy memoranda which led the U.S. to evade the Geneva conventions. When are the lawyers going to bring Yoo, Delahunty, Gonzales, et al., before the Bar to answer for their malfeasance?
The Talking Dog: Given some practical restrictions associated with personnel levels, difficult supply lines, and the sheer number of prisoners involved, it’s fair to say that medical personnel in the field in Iraq (at a place like Abu Ghraib) were under difficult circumstances; other than properly fill out reports of abuse for use in later investigations (which you indicated the record shows was more of the exception than the rule), refuse to participate in coercive interrogations (or terminate them on medical grounds), and advocate for more supplies, more personnel, better food, sanitation, etc…. what would you have individual medical personnel do to discharge their professional duties? Are you aware of whether individual military medical personnel have resigned in protest over these matters?
Steven Miles: I am aware of a a psychologist who asked for transfer, a psychologist who protested, and a medic who was discharged for protest. This was not a matter of supply lines. Bagram, Abu Ghraib, Bucca, Mercury, Qaim all had adequate logistical support.
The Talking Dog: Is there any evidence in the record to indicate that the DOD’s levels of inadequate medical staff and supplies (and food) for prisoners was deliberate in any way (such as intending to “soften up” prisoners for interrogation) as opposed to simply part of an overall failure to plan for a post-invasion occupation?
Steven Miles: The lack of mental health care was entirely consonant with Rumsfeld’s policy directive to exploit the prisoner’s emotional vulnerabilities in a total interrogation environment where the guards worked in collaboration with the interrogaters. There was also a wholesale failure to plan for POW camps. Even so, that does not excuse policy choices such as failing to provide TB screening or picking prisons that were exposed to mortars, snipers, and RPGs when safer sites were available and mandated by Geneva and Army regs.
The Talking Dog: Do you have any reason to believe that the inadequate medical record keeping you have described in your book was actually the result of a planned policy decision (to undermine a later paper trail for abuse, for example) as opposed to simply the result of inadequate or non-existent training, understaffing and unclear protocols?
Steven Miles: Aside from the false dates and delayed release of death certificates, the inattentive record keeping was a result of overwork and the failure to make medical notes about abuse occurred in that context coupled with a radical dehumanization of the prisoners so that the medical personnel simply did not record or report victims of assault as they normally would. The delayed release and false dating of death certificates was so uniform that it appears to represent some kind of as yet unidentified directive within the
Armed Forces Institute of Pathology and its Office of Medical Examiners.
The Talking Dog: Do the records show that the problem situations you have described have been improving over the course of time, or have these problems remained in effect?
Steven Miles: The prisons remain insufficiently transparent to answer this question. DoD has not supplied a complete list of prisons or prisoners. DoD does not allow the ICRC to privately meet with prisoners. It has not supplied a complete list of names, death certificates, autopsy reports, and death investigations for prisoners who have died in custody. Although it recently moved 14 prisoners from prisons in third countries, rendition prisoners,
this leaves about 200 to 300 persons unaccounted for. It has not agreed to fully implement all the Articles of the Geneva Convention and the Convention Against Torture.
The Talking Dog: Your book describes the unfortunate history of torture, including the realization in the Western world around the time of the Enlightenment in the 18th Century that it was, in addition to barbaric, not particularly effective at actually achieving “the truth”. And yet, it has made a resurgence, although our own government has concluded that torture is not a reliable “truth extraction” method. Your book indicates that Secretary
Rumsfeld was advised by experts he convened that coercive interrogation
methods were likely to be ineffective (or worse, lead intelligence officers
on wild goose chases), and ordered the harsher methods anyway. How clear is
the record that the Secretary was specifically told of this? (My reading of
your Chapter 1, footnote 56, refers to the April 4, 2003 “Working Group Report on Detainee Interrogations in the Global War on Terrorism“,
and seems to have a reference to Army Field Manual 30-15 and the historical findings that coercive interrogation methods do not lead to reliable intelligence, but not too much else on that specific “effectiveness” point, though the report, of course, notes the myridad legal restrictions on the use of torture, as well as the practical considerations of threats to our own personnel.) Is there evidence of complicity in the torture decisions higher than Secretary Rumsfeld?

Steven Miles: Secretary Rumsfeld himself appointed the DoD working group on interrogation techniques to revise a policy that he had authored the preceding November. One must assume that he both read and was briefed on a policy document that he personally signed. Pages 52-53, 56-57, 68, 69 make a number of factual claims about harsh interrogation: “interrogation experts view the use of force as an inferior technique that yields information of questionable quality” [which has] “adverse effects on future interrogations,” [may] “damage the admissibility of evidence,” “harm public support for the military effort,” “endanger Americans who become POWs,” and which “would constitute a significant departure from traditional US military norms and could have an adverse impact on the cultural self-image of US military forces.” Furthermore, he had an opportunity and responsibility to question his experts on the background for major claims, especially claims which suggested that the interrogational techniques that he was preparing to authorize might be ineffective and counterproductive.
Aside from the President’s February 7, 2002 directive which suspended the provisions of Geneva Convention, I can not trace the specific authorization for torture to an official higher than Secretary Rumsfeld. It noteworthy that the President’s directive follows virtually word for word a similar directive that Secretary Rumsfeld issued three weeks previously.
The Talking Dog: You discussed a Colonel Larry James, Ph.D., who was involved in designing interrogations both at Guantanamo, and later at Abu Ghraib (and a participant in the American Psychological Association Task Force studying military interrogations). General Geoffrey Miller, of course, was in command at both places, as well. The military has elected to charge NCOs and privates with the Abu Ghraib abuses, and no one else, asserting, of course, that the abuses in the pictures that came to light were the work of “a few bad apples”, rather than the result of any kind of DOD institutional policy or broader command responsibility. Are you aware of any other medical personnel who were also involved at both Guantanamo and Abu Ghraib (or the locations of any other known abuses)?
Steven Miles: My book gives other names and I would prefer not to name them here without giving the full background for each name for legal reasons.
The Talking Dog: Are you aware of whether there were any specific allegations of abuse on the part of Colonel James, at Guantanamo, Abu Ghraib or anywhere else?
Steven Miles: No.
The Talking Dog: You’ve noted that prior to the Abu Ghraib photographs being published, around April of 2004, all American troops captured in Iraq were returned alive, and yet, after that, we have seen beheadings and other atrocities against our troops. (Indeed, the first, Specialist Keith Maupin, was around 2 weeks after the Abu Ghraib photos came out). One can certainly infer that, for example, the fears of the Judge Advocate General’s corps that mistreatment of prisoners in our custody almost guaranteed reciprocity were realized, and Americans’ giving up some semblance of the moral high ground where we needed the cooperation of the local populace for our own mission was itself not a really good idea, by and large, would you agree that most Americans simply just don’t see the relationship between our mistreatment of others and the mistreatment of Americans?
Steven Miles: Most Americans see torture as a form of brutalization of a person. They do not understand that torture destroys civil society. Indeed in most cases, torture is used by authoritarian regimes with the intent of destroying civil society. To this end, journalists, activists, lawyers, teachers, students, labor organizers, and intellectuals are its primary targets. The use of torture in Iraq has made it impossible for the United States to serve as a midwife to civil society there. It has undermined the credibility of our appeals on behalf of the humane and legally fair treatment of proponents of civil society in countries like China or Myrnamar. At the largest level, promoting civil societies must be the overarching policy objective of the United States and other democracies. Such societies are necessary for peace as well as global public health and successful economic development. At the end of World War II, the international community concluded that no appeal to the needs of national soverignty could justify or excuse torture or genocide. The United States has undone that momentous conclusion. It has authoritatively introduced into international relations the precedent and assertion that a national executive with the assent of the national legislature may practice torture in the context of a national emergency.
The Talking Dog: Would you agree that our media is complicit in this in its coverage, indeed, not doing the kind of exhaustive follow up you have, and more or less accepting the “few bad apples” explanation as given? What kind of media interest has there been since you published your book, and I include both U.S. and international media in that question?
Steven Miles: Our national media failed at many points in this story despite excellent reporting on some aspects of this story. It allowed the “ticking time-bomb” fantasy to go unchallenged. It ignored authoritative human rights organizations reports of torture to go largely unheralded. It has failed to explain the deeper significance of anti-torture codes, as I discussed in a my preceding answer, to the public and legislators. It sanitizes the torture story as it ironically gets increasingly graphic in its depictions of fictional torture. Where are the pictures of the women being abused? Why are buttocks displayed on television dramas and pixillated out of prisoner who are being abused? Who is keeping score on military prosecutions? Why does the media not discuss the potential for an indictment or subpoena to the international criminal court for key US officials? Why did the media not cover our insistence the Belgium water
down its war crimes act as a condition of getting US funding for a NATO
headquarters building renovation? Why does the media continue to use
journalists who are simply reporters rather than regional experts who can provide context?
The Talking Dog: You’ve suggested that the publicly available (i.e. declassified) data that you have reviewed was “scrubbed” of mention of atrocities (particularly homicides and rapes) against children, and in many cases, women, though in the case of photographs of the latter, for example, media organizations have held back release of photographs of women who have been abused, though are records of abuse– perhaps or probably rising to the level of war crimes– against both women and children in the investigation reports you have read. Since the publication of the book, have any additional data emerged on this point, and can you tell me if you are aware of whether media are complicit in this “scrubbing”, for example, if DOD has asked them not to release pictures of women abused, or if something else is going on?
Steven Miles: I do not know. The material that you cite is in documents. The media will not carry it. I have a planned publication on the children.
The Talking Dog: Since your book was published, three Guantanamo detainees have committed suicide. Do you have a view on medical personnel complicity in that, to wit, do you believe that medical personnel at Guantanamo are complicit in those suicides, and if so how? Do you have a view on the ethics of forcefeeding hunger striking prisoners at Guantanamo (or elsewhere)?
Steven Miles:On June 11, three men at Guantanamo hung themselves to death with bits of cloth. Guantanamo did what it was designed to do, break prisoners down. In February 2003, the US government declined to answer Amnesty International’s request for an evaluation of why many prisoners were attempting suicide at Guantanamo. The Defense Department concealed those efforts under the euphemisms of “hanging gestures” and “manipulative self injurious behavior.”
The policy of breaking prisoners down was run from the top down. In April
2003, Secretary Rumsfeld directed, “Interrogations must always be planned,
deliberate actions that take into account . . . a detainee’s emotional and
physical strengths and weaknesses. Interrogation approaches are designed to
manipulate the detainee’s emotions and weaknesses to gain his willing
cooperation.” This translated into a policy of integrating the treatment of
prisons in the interrogation rooms and the cellblocks under a single interrogation plan.
Breaking prisoners down became a medical specialty. Mental illness was
ignored. Signs of beatings went unrecorded in medical charts. Medical
interviews and records were culled for clues on prisoners’ vulnerabilities.
Mental health personnel monitored interrogations and reported to interrogators. When the prisoners, most of whom know nothing of terrorism, protested or despaired by refusing to eat. Clinicians strapped them into chairs and force fed them so that their indeterminate sentences could continue.
Five days before the prisoner’s suicides, the Defense Department issued a
document entitled, “Medical Program Support for Detainee Operations.” It endorses the old abuses. It does not say that clinicians must obey the Geneva Conventions for Prisoners of War or the US War Crimes Act. It says that clinicians “shall not certify the fitness of detainees for any form of treatment or punishment that is not in accordance with applicable law.” But, this wording allows doctors to certify prisoners for harsh interrogation in accord with our Orwellian interpretation of International law.
It makes the prisoners’ hunger strike protests illegal without abolishing the unlawful prison procedures that have engendered those strikes. When a prison is designed to make war on disarmed captives, it is easy to understand how a Rear Admiral Harry Harris could lose his bearings and claim that these suicides were “an act of asymmetric warfare waged against us.”
The Talking Dog: From the records you have reviewed, regardless of the practical political impossibility of further action, do you believe that we have enough evidence (1) to reasonably conclude that medical personnel have been complicit in “grave breaches” of customary international law, to wit, the Geneva Conventions of 1949 (a/k/a “war crimes”), (2) to reasonably conclude that there was sufficient “command” involvement in those grave breaches to conclude that military commanders, up to and including the ranks of general, secretary of defense, vice-president or president, to implicate those individuals for involvement in the grave breaches?
Steven Miles: We have enough evidence to conclude that grave breaches of the Geneva Conventions have occurred. A court is the proper place to determine culpability for those war crimes. Unlike Court Martials which proceed from the bottom up the chain of command, a war crimes process starts on top and proceeds downward. I think that the world community will have to look to Europe to bring the subpoenas which could begin a war crimes investigation. Sadly, the United States seems to not have the political will or cultural strength to do so.
The Talking Dog: Thank you, Dr. Miles, for that incredibly informative and thought provoking interview.
Readers interested in legal issues and related matters associated with the “war on terror” may also find talking dog blog interviews with attorneys Michael Ratner, Thomas Wilner, Jonathan Hafetz, Joshua Denbeaux, Rick Wilson,
Neal Katyal, Joshua Colangelo Bryan, Baher Azmy, and Joshua Dratel (representing Guantanamo detainees and others held in “the war on terror”), with attorneys Donna Newman and Andrew Patel (representing “unlawful combatant” Jose Padilila), with Dr. David Nicholl, who spearheaded an effort among international physicians protesting force-feeding of detainees at Guantanamo Bay, with law professor and former Clinton Administration Ambassador-at-large for war crimes matters David Scheffer, with former Guantanamo detainee Shafiq Rasul , with former Guantanamo Army Arabic linguist Erik Saar, with law professor and former Army J.A.G. officer Jeffrey Addicott, and with law professor and Coast Guard officer Glenn Sulmasy to be of interest.