C06541727 Approved for Release: 2018/08/14 C06541727 Summary and Reflections of Chief of Medical Services on OMS Participation in the RDI Program 1 Approved for Release: 2018/08/14 C06541727 C06541727 Approved for Release: 2018/08/14 C06541727 'f'SF . (b)(1)------ ~EleR~'i'/ C(b)(3) NatSecAct l/MO!'Oitlil I ' AL QA'IDA DETAINEES: the OMS Role Press attention to the Agency's interrogation and detention p~ogram began with'the 2002 capture ofAbu Zubayda~~;;lf.a~d again with the 2003 capture ofKhalid Shaykh Muhammed, accelerated in 2004 in the wake ofAbu Ghraib, and then exploded in 2(/f/lkllg,wing a number ofsignificant leaks. By 2007 hundreds-perhaps~ousan~s~f articles and editorials had been published on what ar,~ably.,has become the most controversial program in Agency history. Jji.f.;;,~dfrom withi~ resulti~g public pictur~ re~ains as ~~~a.1°fg_:.icature as fact. If tlie ~~~ i~­ any guzde, however, this dzstorted pzcture~w.z!l beco.me.the accepted P.,u'b1zc history ofan important chapter in Agency kis/o_ry,:·-;:Wiih\both present'?!ind fature implications for those within the Office.o/M~dical Services. These implications warrant a more lJiy"d internal aC,;QW..t ofhow OMS understood and experienced this 'P ogr,qm at the time.~iY"· \. ~ ~(. ·.~:-· · J• /; Introduction and Contents~ J ,:.,......\.!·[J?.:--1 J.-->,,. ..... The Context {p. 2J pioo J-2@~!1J . Saving the life ofqdlfg~.[alue: Ta.rget (HVT) 'fl!. 6} {2002} Embracing SERE (Sul-viral, EvtiSion,_Resistanc~scape) [p. JO] [2002] Initiation of.',;~n_bgnced i~i!?rrogatiori. techniqffes" (EIT's) {p. 18] [2002] The ques1tpnf.0J~nu~•assisted interrogation--' {p. 23] [2002] The ~~of Psych~l-~nd P~rc.~~atrists {p. 26] [2002-2003] Ear/y'Nf~a,..kes [p. 31]~002-2q~3j KSM anlNhe Waterboar~"f:fp. 36]' ·[2003] HVDs, El~(l~'\.OMS Gui'iielines {p. 48] [2003-2004] Problems ofDetention f [2003-2006} Exposes [p. 63J 'tfl.O.Q4-20V6} Ethics [p. 68} [200~~'!o7J An Unfinished Chapt°fr [p. 77] [2005-2007] Interim Afterthoughts {p. 84] Pl!l 1 Of necessity, some broader program information is included in this chapter, to place the OMS role in perspective. Agency rendition. interrogation, and detention efforts were much more complicated than these glimpses suggest. - ~---------~ (b)(3) CIAAct (b)(3) NatSecAct (b)(3) NatSecAct 'l!QP SEE'ft!:T / j ~OFSitt~//MR Approved for Release: 2018/08/14 C06541727 C06541727 Approved for Release: 2018/08/14 C06541727 .(b)(;:$) ~OP (b )( 1) (b)(3) NatSecAct r · Nat~ecAct SEERE'f/ /H8F'8R!i//HR (b)(3) NatSecAct The Context b S9)tember 11, 2001 began unreqiarkably. C/Medical Services arrived in ~here OMS was providing temporary medical coverage, (b )( 1) · · o d d l y , no one would answer the door at the station even though officers could be (b )(3) NatSecAct seen inside tightly gathered around a television. The World Trade Center's South Tower just had collapsed; a few minutes later the North Tower came down.2 The Pentagon was hit. All were targets of hijacked commercial jetliners, so U.S. domestic flights were being ordered to ground and international flights turned away. _..,.":>-., ·~t Headquarters that Tuesday, I . " $~ :,?~~~g activities wei:e sharply mterrupted by news of these attacks. Ommously,?ai!four.th'.jwJacked plane was · headed toward Washington. The Capitol and C.I.A. Hea'ti~uarte~-w~r:e believed prime· targets. With less then 30 minutes until ETA, an i~iat~ evacuaiiofl._efthe buildings · was announced, excepting (at CIA) emergency P.e'Kcmnel such as thos~,~~inedical. As the minutes passed, most eni.ergency personnpliff~ecated t~below ground ~ors' while (b)(3) CIAAct=1and a few others remained in the first floo ica:lf$a~es. (b)(6) In retrospect, the Capitol app~s ..~o have been tlie final 9/11 targ~t, though this was averted when passengers forced Fljght"93 _to crash in PeF!Asylyania. Nonetheless the events that day were the most galvanizihg'siae.~.P~C\fl Harbo~~- .within a week, the (b )( 1) President signed a Memo~andum ofNotifi:~tioQ:·(M9N) (b )(3) NatSecAct ~n"'·~~-IU~d-in_g_'_'o-p-er-a-tio_n_s_d_e_si_gn_ed_t~o 1' I capture and detain per;sprl§;·w~~"pose a contirt~_ing, serious threat of violence or death to U.S. persons and int¢r.e~ts or w~o;are planning,'.terrorist activities."3 perpe;~~~·r~ ~(¢.e~~i~}:'a~acks .w.~~entified ~al-Qa'ida The terrorists, and there was imnremlit~,~nce'm.,~uta~~·•roHb~~~n" attack. As then DCI Tenet later recalled, .~~r;e gofi.epprts: of nuelear weapons in New York City, apartment buildings that are go~a be blown up; pi3.nes th1t)..,7ionna fly into airports all over again, plot lines that I d6~lq1ow. I don't kp~w wh~t's going on inside the United States? and I'm struggling to: f.il1d out whertthe next disaster is going to occur. Everybody forgets one central context ·o(what we lived through: the palpable fear that-we felt on the basis of the fact that there wa1)!i>.!l1U.9~;·tve did not know." 4 Lacking concrete intelligence, extensive lists of potential tai"get~.:Were drawn up, including the country's physical infrastructure (power plants, bridg¢s;.subway systems), symbolically.important buildings, theme parks, · (b )( 1) (b)(3) NatSecAct I 3 Office of the Inspector General, "Counterterrorism Detention and Interrogation Activities (September 2001 - October 2003)," 7 ~fay 2004, p. 1. The MON was sighed 17 September 2001. 4 "'60 MINUTES' -- Tenet Defends High Value Detainee Program," CBS News.com, 25 April 2007. Tenet laid out the context somewhat more fully in George Tenet, At the Center ofthe Storm: My Years at the CIA . (New York City: HarperCollins, 2007), Chapter 13, pp. 229-258; \ 'f8F SElCRE'i'/ [(b)(1) (b)(3) NatSecAct Approved for Release: 2018/08/14 C06541727 2 / (b)(3) CIAAct (b)(6) C06541727 Approved for Release: 2018/08/14 C06541727 (b)(;:$) Nat~ecAct !OP SECRE't/ /NOFORN//MR (b)(3) NatSecAct malls, and major forthcoming events such as the World Series (which was postponed a week), Super Bowl, and the Salt Lake City Winter Olympics. While the possibility of a nuclear attack initially could not be ruled out, 5 the greatest emotion surrounded potential chemical or biological attacks. Anthrax was the single most likely biological threat, so OMS quickly a~uired a large supply of ciprofloxacin (Cipro); and, in case of chemical attack, a stockpile of atropine autoinjectors.6 OMS also arranged briefings on the Agency's best judgment on potential threats for senior medical personnel from State D~partment, NS~pl, HHS, the White House, and Congress, and compared emergency medical i;-espopse plths. · . In late Ociober concerns elevated sharply whOn IAnirig anthrax spores were delivered to Capitol Hill, fatally infecting some postal work1,n{oute. Government agencies, including CIA,.began specialized\sc}eening in tii:\r,mail facilities . and CIA was one of several to find trace amouQts[oi' anthrax. Given the~~unt discovered, ?MS judged th~t only a handful &>f.p~te~tiall_YJ;~posed employ~~needed to be offered Cipro prophylaxis, but DCI Tenet announ_eed tt-;..would be made (\:vatlable to any concerned employee. Emergency distribution wa~·~ged for the following day-a Saturd.ay-and involved most ofthe@MS headquarters·'s~f:t; Several hundred anxious Agency employees came in for individem e:\mluations and 'CS~seling, and were issued · medication. Tenet visited during this o~ratien,. ~9-t! mentioJ.C/MS that he thought it "a slam dunk" that al-Qa'ida was behi~\this at!S~Jf.~~- ·-·· '-~ · ~' ~(/ ...,,,_.,_ . .. ·" ·' (b )( 1) Anthrax-contami&ibail also pa~s~~hrough'·~~tate Departmen~ distribution center, potentially CQbTuminatia'ghmtgoing di~lomatic pouches. This threat, combined with the incidentaf''Ciu~'t·~ foun4 1~ .old pouche~31d hoax powders mailed to many embassies, spawned local.¢s.~s-~~gr1Cl~------------ 3 . ,;:.gency. (b )( ) NatSecAct ~.~4~'cllmi~ mail was halted until a method for de~ntarlii.\ation could be.id~ntifiejif° OMS's Environmental Safety Group took the lead in this proj~t-~~d soon w~ ,directly running a heat-based treatment program for all incoming mai'l~OMS also ~as at the forefront of an effort ~o identify suitable perimeter, portal and building . C~RN¢screening devices, which~ventually led to an extensive headquarters monitof.iP,g:program. r Later analysis concluded that the October anthrax attack probably was the work of a disgruntled domestic scientist, rather than international terrorists; and that all detected anthrax could be traced back to distribution centers contaminated by leakage from the s Maps, probably dating from the 1950s, were provided to OMS outlining the potential effects of a weapon detonated on the Mall Some auto-injectors were issued to the Security Protective Officers, believed most likely to be exposed to a chemical attack. The only actual use of an auto-injector came when an officer inadvertently discharged one into his own leg, thinking it was a demonstration dummy. 6 3 j(b)(1) . .,,..l'"ln-p-.s~E:!"l'C'"'l!Rl"'llE-T I 4-(b )(3) NatSecAct Approved for Release: 2018/08/14 C06541727 C06541727 Approved for Release: 2018/08/14 C06541727 (b)(;:$) Nat~eCACt1 ·'faF 8EenT /I I/MOPO!t'M//Mlt ·~I~~~(_b)_(3_)_N_a_tS_e_cA_c_t~~~~ two spore-containing letters mailed to Capitol Hill. Nonetheless, the extensive press coverage highlighted U.S. wlnerability to this type of attack and the high cost of responding. (b )( 1) Concurrent .with. these developments and with the Presidential MON in hand, the Agency moved aggressively abroad. Intense efforts were mounted jointly with foreign intelligence services to round u al-Qa'ida o eratives worldwide. (b)(3) NatSecAct Over th'.e·riext five years, OMS either to or ~P_A_s_o_r-ph_y_s-ic_i_an_s_a_cco_m_p_an_i_ed_at_l_eas_t_l_2_0_o_f_th_e_se-renditi~ights-most between newly established CIA facilities. 7 ::/ '':.· --· ~.... The pre-rendition medicitl exam included ~i1dt"ca~ty search (a:.:component of which was a rectal exam), which in later years ledi:to an occasional char~t CIA. administered drugs rectally during the renditio~ocess. The PA (or occ (.nally an OMS physician)' did carry medical supplies for emergency use,.. but only ·once was a dangerously agitated detainee sedated during flight. 8 Eventually a few of those being transferred-mostly long-term detainees-were medicatecla.voluntarily for cpnventional medical reasons (e.g., one requested a ~lt(qJi pill for the1tigbt). No one ever was ~.' medicated rectally. . th~lib-wl ~;~~int At the time of the 9!11.attacks of Afghanistan was hosting the al-Qa'ida. leadership, its training~ps, and'Teveral potential chemicaV biologicaVradiolo~cal/nuclear sites. In mid-~~tober 2001 (concurrent with the anthrax scare) the U.S. latfnchea a combi.t_ied attack agifus(the Taliban. The offensive brpught together small independently ~peratjngjpJ.Qt ~IA-Special Forces teams (which included (b )( 1) OMS PA'~).,J (b)(3) NatSecAct and U.S. ai1110wer. By,ffeiig-December all major Afghan cities• had been taken. : · ,_:. ./> • l ~eek majoifi~an after the last . city fell, al-Qa'ida "shoe bomber'' Richard Reid att~t~ to blow upieo:mniercial jet en route from Paris to Miami. A month later Wall Street Jou~,al report~aniel Pearl was kidnapped in Karachi and demands were issued by his cap~···,a few weeks later his decapitated, dismembered body was found, '· (b )( 1) (b)(3) NatSecAct 0 Valium was administered onl I lfligh1 • 4 . "'f'fieep:p..-i::slii!Bfe:~~li3:;;q'r / [(b)(1) ( b) (3) Nat SecAct Approved for Release: 2018/08/14 C06541727 (b )( 1) (b)(3) NatSecAct NatSecAct NaI~eCACI C06541727 Approved for Release: 2018/08/14 C06541727 (b)(;:$) Nat~ecAct 'f'OP Sf!:at!!T/j . l/MOPO!tMf/M1': ~I~~~(_b)_(3_)_N_a_tS_e_cA_c_t~~~- and a week after that a video of his execution was released. Although more than 2,900 al-Qa'ida operatives and associates were in custody, in 90 countries, 10 only one senior alQa'ida leader (Atef) had been killed (by an airstrike in November), and none had been captured. The U.S. remained braced f~r the next terrorist attack. In March 2002 the newly created Department of Homeland Security established color-codes to quantify the estimated level of threat. These ranged from green (low), through blue (guarded), yellow (elevated), orange (high), to red (severe). With little hard intelligence, these levels were based largely on unconfirmed repqrts,, non-specific terrorist "chatter," and intelligence supposition. The first anno\inced·level. that March was yellow, or "elevated." ~f:,·· ,,:,. .:'. ··..::··:~,... . ..... · ~ . ., 'I. . • .( ' ,,, k~i~, ~ ·::~ ·''·· .., ·. : . ,. .: ' . . .· ,.• .. r ... ....... ~·...;.·,. ' '<-.~··· . 10 The first 20 military detainees to be sent to Guantanamo Bay arrived at Camp X-ray, on January 11, 2002; by th~ end ofFebruary about 300 had arrived, and by the end of the year, over 600. I. ':POP SEQRl!:T/ 5 j(b)( 1 ) --------"~(b)(3) NatSecAct Approved for Release: 2018/08/14 C06541727 C06541727 Approved for Release: 2018/08/14 C06541727 (b)(;:$) Nat~ecAct b 'fOP s:ee:ttE'f/ /HSPSRM//l~ (b)(3) NatSecAct Saving the life ofa High Value Target (HVT) (b)(3) CIAAct (b)(6) (b )( 1) (b)(3) NatSecAct (b)(3) CIAAct (b)(6) 11 In a brief to the Department of Justice a few months later, AZ was described as al-Qa'ida's coordinator of external contacts and foreign communications, its counterintelligence officer, and to have been involved to some extent in Millennium plots against U.S. and Israeli targets, and a 2001 Paris Embassy plot, as well as the September 11 attacks. · 12 U.S. military medical facilities were not considered an option as the resulting public exposure would ~eatly reduce AZ's value as an intelligence source 3 Regional coverage during this period was a challenge; ( b) ( 1) (b)(3) NatSecAct ':FOP sBGali:T / r(b )( 1) ----l(b)(3) NatSecAct Approved for Release: 2018/08/14 C06541727 (b )( 1) (b)(3) NatSecAct C06541727 Approved for Release: 2018/08/14 C06541727 _ (b)(;:$) Nat~ecAct 'f'eF :3EatET I J I /MePom//Mll (b )( 1) (b )(3) NatSecAct (b)(3) CIAAct . and clothes. . ( b)( 3 ) NatSecAct return home. the PAs went to a local mall to buv su1tcas~s. who Jomed the team~a-tth_e_a_tr_po_rt _ __ I I 1 (b)( 6 ) I where the senior PA took him to phone booth and had him sign a secrecy agreement. Twenty-four hours later the team was setting up atl I ' AZ had been shot from the ground while attempting to escape along a rooftop. Initially reported to have been hit three times, his wounds were the result of a single bullet which entered his left leg anteriorly just above the knee, passed deeply through muscle tissue and exited anteriorly in the upper thigh, then reentered the lower abdomen. surgeo1(b )( 1) Fragments ended up embedded in the posterior abdominal wall'\' done an exploratory laparotomy, repaired some bowel dam~g~·administered seve(b)(3) NatSecAct of blood, and left behind the less accessible fragments; t~~)eg wounds received only " .· ··;;~. . superficial attention. ... "~· On March[] an FBI EMT present for !b.~·Zuba;dah takedo~ a~~ed that 1 i'"an4 ·he was (b )( ) although AZ remained "s tic" in a earanc~filii§:vital signs w " (b)( 3 ) NatSecAct "stable for travel." RMO joined the teaqi and the AZ 'Yas collect (b )( 1 ) - - - rendition flight immediately departed (b )( 1) d the fli ht continued (b)(3) NatSecAct (b)(3) NatSecAct . ~---------- Duri~~ the-~.,AZ was agitated, and his breathing somewhat labored, so small doses ofVaHWli w~•a@'.i~Wstered to allow him to rest. facility;-'tfi;[:'(b )( 1 )IRMO then continued Having safely delivered AZ.to thel (b)(1) on with the rendition team then Q.~ck to his post(b)(3) NatSecAct (b)(3) NatSecAct On evaluati~n at1 IAZ was found to have a small entrance wound in his lower thigh, a large, fist:s"it:d-~'¥iiZ:we.1:1IlnXpril 61h a f~ had retfi#Foot'apparently triggered by a deterioration of his leg.~~d. On t~e~_consecutive qays (April 6-8),I_ ~urgeon (assisted by an' OMS P~), debrided necr.\)ti9 tissue from the wound, which ultimately left the bullet tract (b )( 1) · clean but~A!ely laid opei:(~png its entire length. A final debridement was accomplished 1 (b)(3) NatSecAct two days lat't: ·j~;. . / . aiia. . ~ As AZ's leg infeGfl'on and respiratory problems came under control, new concerns presented.'· Afitfng amylase, worseni~g liver function tests, and a falling . (b )( 1) hemoglobin (never definitively explained) led to the discovery of an intra-abdominal (b )(3) NatSecAct inflammatory mass near the site of a bullet fragment. Reluctantly, an exploratory laparotomy was considered, but fortunately proved unnecessary. An endophthalmitis also developed in AZ's left eye, which had been opacified at the time he came into ophthalmologist recommended urgent enucleation, ·to avoid Agency h~ds. 15 E.g., Los Angeles Times and New York Times, both 3 April 2002. The present account is not meant to be a detailed medical history; the few specifics given here are intended only to give a general sense of the case. . 16 8 r(b)(1) yep SBCRB'%'/ 'L(b)(3) NatSecAct / Approved for Release: 2018/08/14 C06541727 (b )( 1) (b)(3) NatSecAct C06541727 Approved for Release: 2018/08/14 C06541727 · (b)(;:$) Nat~ecAct 'f6'1 Sl!'!CltEI/ J l/MOl"O!tM//IVM (b)(3) NatSecAct involvement of the good eye. OMS, in consul_tation with cleared Washington-area specialists, opted rather for antibiotics and culture (which proved negative). This inflammation soon resolved~ and eventually the left orbit atrophied without further complication. These proved to be the last of AZ's medical crises, and with his continued improvement, the intensivist departed. On April 12th he was moved from the ICU to a VIP suite; afebrile, pain-free, on a full diet, with a leg wound now healthy in appearance, ·and able to get up and down on his own. Medical concerns were;now replaced b~ (b )( 1) operational concerns.I I (b)(3) NatSecAct Now despite a 24-hour Agency'bedside presence, AZ was poteiffiallyt\9,1.e to speak tc(b)(1 staff; which could reveal.his identity and thus wh~ '\:' (b)(3) NatSecAct )I On April 15th, after just three days in thtM?rivate suite, but two wee~ after his 1 (b )( ) admission and nineteen days since his gunsh(Jti~~~d, AZ\w.,~s transferred,sk-1io 7 (b)(3) NatSecAct A headquarters-based physician, ER-quali_fl~d-·nl.!rse, and new1PA arrived ............ to take over care .. By month's end, a continuous physi~ian .... w, and PA presence no longer ( were needed, and for the next three niBIJP1S AZ's day-to:.·--'. . .... /•f" ."'. . . With his le_$~~~~d visi~ly healing, ~~s pri~ary medical concern was a mild prostatitis (manifest oitly-l?Y a tta£e of blood in~fiisfsemen), which'he feared was the first sign of an impending lo.ss.of '.~tjiai$.ood,"_. ije.illro was inclined to focus on other minor complaint~_,,;"e~P..~ially durlqg·periods -of. in~ehogation-including some knee discomfcf1( intesti:ll!_~aiiis~llf'd a mild reflux esophagitis. Basically, however, he was ;i-fifalthy young man, given 'tJ!§'om~ hypochrondriasis. ,: !~ . '.... .~~·· ~~' 17 Versed and morphine were given to ease the transfer. 9 TIP r(b)(1) t SECRB'f/ 'L(b)(3) NatSecAct----__,__ue_F_e___,ji Approved for Release: 2018/08/14 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct TOP SECREI/ ~-- /l'JUPORN//MR (b)(3) NatSecAct Embracing SERE (SuriJival, Evasion, Resistance, Escape} The circumstances of AZ's capture had not lessened the urgency felt to question him about a "second wave" of al-Qa'ida attacks. Later press reports claimed that not only did his injuries not delay this questioning, but that his acute pain was exploited. The most detailed version of this myth had Agency doctors installing· an IV drip through which a short-acting narcotic painkiller was switched on and off, depending on Zubaydah's degree of cooperation. 18 In actual fact, AZ was ~ot interrogated during the painful phase of his injuries (for much of which he was on a respj.i:~tor), or at any point while he was in the hospital. At no time then or.tater were m~(jjc~ti~s of any sort ~<· withheld. .',. The ~nt~rrogat~on ap~roach in~t~ally taken. wi~p::~~,.~as ~el.a~y conve~~ional. //''··~ . . Withm the hmits of his medical condition, these UJYGlvea,a combmatio~~f positive and negative incentives, with the expectation that mpd/st pressures would ~;ltecessary to weaken his psychological defenses. Permissi,.o'n~~).1~e a.f~"".~on-physica~ldly (b )( 1) aggressive techniques, if necessary, had been grante9'jµst~6nor~to his retumlfrom the These included an austere ceit;{tijhited clothing, sleep (b)(3) NatSecAct hospital! ' deprivation, bright lights, white noise';':~d dietary maniptilatlon (i.e., a nutritionally adequate diet of Ensure supplemented\yi;~:~~ins). Under 'tl:i,~yjrcumstances, "positive" incentives would be the re~f'w.illi.drawn amenltjt?s;' such as the return of full clothing,· a more comfortable chair onsleep~, efli, and a more interesting diet. .... I y 7 . This ba~icppro.ach, 0 ~learned, .w.~~r~wn mostly. from the military'~ SERE (Survival, Evasion, iiffistance, Escape) traimn~j\?rogram. With antecedents datmg to the ,Kor~~ yv_ar, ~~~ ~as-~i~~ re mi.llit~ p~onnel fo~ capture fannhanzmg!!li. .~ h~ mtgli • ~to vanous mterrogatton techruques, and offer s~m~oping ski~1ls;.Jt was Uie only extant U.S. program to subject personnel to physicafanterrogation me~ures. I· j··-.~~;~ '~ ·:... ·.,\._ . At on~·tjme OMS P,S~chologists, psychiatrists, and medics were extensively involved in a'S£:RE-like Ag~ncy P,rogram also designed to prepare employees-initially ?Y .. (b )( 1) U-2pilots-ag;tl~~~~e130,ssibility of capture and interrogation. OMS staffers assessed (b)(3) NatSecAct candidates, monitot~<;ipafticipants, and even served as instrllctors in this program . ~";' . ~-~ .::/ 18 Gerald Posner, Why America.Slept: The Failure to Prevent 911 I (New York: Random House, 2003, pp. 184-186. . 19 During the Korean War, many American POWs collaborated to some extent with their captors. This was believed the result of interrogation techniques, which might have been resisted more effectively had previous training been available. As a result, by the mid-1950s several SERE-like training programs had been developed and implemented. When the SERE antecedents of the Agency program finally were Widely publicized, particularly in 2007, it w.as .popular to say that SERE techniques had been "reverse engineered" to produce the Agency (and military) interrogation techniques. No reverse engineering was needed, however; the interrogation techniques used on SERE trainees were simply used on detainees. 10 T

.sychologist, Bru'(lessen, and eventually · · an d o eve1opmg. · 't'--:g;c · -. "l-'.._ A,., -ti( •1·da Res1stance · pro du ced "Recogmzmg ·. ounienneasures to ..~3~a to 1 Interrogation Techniques: A Resistance 'Fi~ning;P~pecti'.'.:~·V°2 Following AZ's (b )( 1) lt6.'s~J:Ve' as a·b~Ii!~cl-the-scenes consultant to (b)(3) NatSecAct capture, Mitchell was sen~toJ interrogators and the on~ittlf@& staff psychqlogist (wh~{was there to evaluate AZ psychologi~ly, ~re popible approa~~;:~ interrogation and debriefing.) Under most circu~stanees~ _irtt~og~t9Jl'Seek to exploit the initial shock of capture, whiclf.Jn AZ~s ca8e'iWas lorig'sihce~past. In lieu of this they chose to take ( b) ( 1 ) · advantag~fbf the "shd~~~.of hi's:.r,~W:m to detainee prisoner status, in the austerity of a . (b )(3) NatSecAct ~--~,.~cell. One d'if~l\~er his~i;~tµfu from the comfortable hospital setting, a three day perie~ interrogatio~as beguh, employing all the previously approved measures. The on-site·.pMS physiciarmt;1onitored this closely, and found that neither the initial three-day period.of sleep depnvation nor shorter periods repeated several days later that week impacted his.~~~~t:ig recovery. These meastires also failed to gamer any °The antecedents ofthis,1nit had overseen much of the M~ULTRA interrogation research in t}ie 1950s and 1960s, published still-relevant classified papers on the merits of various interrogation techniques, contributed heavily to a 1963 KUBARK Counterintelligence Interrogation Manual and its derivative 1983 Human Resources Manual, assisted directly in early interrogations, and (with OMS) provided instruction in the Agency's Risk of Capture training. Bureaucratic tensions between OMS and OTS (and their antecedent offices) extended across 50 years, and again were at a peak in 2002. While concurrent questions of organizational charter, expertise, and placement color much of the OMS detainee experience, this complicated issued is beyond the scope of this history. 21 Mitchell had 13 years of experience in the Air Force SERE program, and Jessen 19 years. Additionally, Jessen had worked with released U.S. military detainees in the Nineties. 2 11 !OP ~HeRe'i' I [(b)(1) (b )(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'fef :3Ee:rt!!:T I j I /MoPom//rvm: (b)(3) NatSecAct drainatic new intelligence. A one day repetition th~ following week was similarly. ineffectual. As the on-site personnel assessed the situation, ''there is unlikely to be a 'Perry Mason' moment where the subject ultimately gives up but rather will likely yield information slowly over the course of the interrogations. The subject currently is taking a highly sophisticated counter-interrogation resistance posture where his primary position is to avoid giving details."22 The next contemplated step-which was approved for use at the end of AZ's first week of interrogation-would have been more punitive: placing him in a "confinement" box akin to that previously used in the Agency's own training ,,gr~. As OMS was advised, confinement boxes had been introduced into SER~.1,fter POW's in Southeast Asia reported being placed in small, uncomfortable b~x~~~ 3 ,60% of the POWs so treated said it led to their cooperation with interrogator.s. ~e pro~s~ Agency box w~ to be 30" x 20" x ~5", which w~ ~ore spacious t~Ro'th the "prot?f~~~E~E box and the .one o~ce used m Agency trammg. The pl~~~as.to co~fine ~ ~n a F~-~~~ box for a trial J>enod of 1-2 hours, repeated no more ~fill -~::!•mes a\d~y, s1milar to untial SERE (b )( 1 ) (b)(3) NatSecAct usage: believed that it would "achieve:~;:~~~~red~~ffect." JY '-;,:' \. OMS, concerned that AZ might accidentally or d~lil>erately injure or contaminate his wound in the box, specified that hen.et he placed on hiS~·~Women and that there be audio and infrared monitoring equipment~ e latter already ~ed by CTC). Ultimately; use of the box was deferred sa that ~·I i!Jierrogat~ could attempt to make a deal in which, ~n exch~~~~ecame an. QTS IC) were tasked with devising a more aggressive approach to iilterro~font;~l'h,eir .~olution was to employ the . X.,\ 7"·" ~'"!'"·.. · . . full range of SERE techt}iques,,,,, They, togetP,$f with otliet,PTS psychologists, researched these techniques, soli9.~:tjrig-iii:f~,.pnation on eff.ectiveness-'.iind harmful after effects from various psycholozj~J~?illsychiitf.i~ts, academi~~, . and the Joint Personnel Recovery Agency (JPRA), whitfi ew.ersaw military SERE;programs. :\;~: ..~'"···..··,,.: As ,l~t~·9.ategorized(Sy··Mitch:etrand)~ssen, the pressures to which SERE-trainees are subj_ected durl'ng·a~.fur~e-d.ay . ~~captivity" fall into three general categories. Cond~tioning techniqu~~~akeri·p.ological defenses and deprive the students of their usutl sens~;~f personal cbpfrol. ~ese include such things as stripping, diapering, sleep deprivatiorf.teie~ary restriction, and solitary confinement; as noted, these measures also provide an o~rtunity for ,p~sitive rewards for cooperation. Corrective techniques are physically puniffve, and ar~·designed to sharply disabuse a trainee of the notion that they won't be touched an4Jgclis them on the interrogators and the questions being asked. These include "atten(ic'in" holds of the face, "attention" slaps to the abdomen and face, and slamming the stUdent against a wall ("walling"). Coercive techniques are the most aggressive of the negative measures, and are designed to accelerate the trainee's entrance into full compliance. These can include placement in stressful positions, confinement in boxes, dousing with water, immersion in cold ponds, and exposure to the "waterboard" (which invokes a sense of drowning through the application of water to a cloth-covering the nose and mouth of a supine subject). At the extreme some SERE programs even used mock burials. 13 T ""'' 'RR'i' / [~~ ~rn NatsecAct-----J-~~Nl~>~Fl~'j~N Approved for Release: 2018/08/13 C06541727 J C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'f6P 3!!C:R:EI/ /NOl'ORN//MR (b)(3) NatSecAct Despite the physical and psych.ological intensity of the SERE program, thousands of trainees had completed the course without physical or psychological aftereffects. In part.this is because SERE candidates (and instructors) are medically and psychologically prescreened, and physicians and psychologists monitored the entire process. All measures, even the most aggressive, are designed and administered to insure the safety of those intertogated. "Slaps" are open-handed, short-arc, and directed at narrowly-· circumscribed "safe" areas; those ''walled" are supported with a rolled towel around the neck, and the blows directed against flexible walls designed to absorb the blow while amplifying the sound; water immersion is limited by ambient air and, water temperature; and water-board applications generally are limited to 20 second$'faii(fno more than 40 ,~ seconds. .-: .·~~~_, ..:~,; . -~-~ By early July a specific pl~ fo~ the ag~essi~~~~; of AZ~~in.~errogation had . been worked out. The goal was to Jarringly "d1slo~te"i11s expectat1o·J)s _q_f treatment, and thereby motivate him to cooperate. (At the tim~ was believed to be"auth.or of the alQa 'ida manual on interrogation resistance; h~s.seemedleJhink ifhe ooula~HO'ld out longer, he would be transferred into the benign H:St¥:-di.9ifo''system.) The i,n7errogations 24 would be handled exclusively by the two contract SERE psychologists, who would escalate quickly through a "menu" of.pre-approved techniqu~s. These were to be ''the same techfliques used on U.S. military;p.~~nnel during SERE~ing" (detailed above), 25 designed for maximum psychological i~p~c~i:~qµt causing~~ere physical harm." A medicai person with SERE experience.;.i.e., ii'serifor OMS4>J\, who.had worked in the previ.o~s Agency program·~~~ to be pre~~B.~;througho~~~d, when warranted, an ?MS phys1c1an. The OMS pi"td1caJ;:oft_icers'uexclus1ve role was to assure AZ's safety dunng . · interrogation. ~~- ":..,;:.:;. \. .~\~~. .. ~ . ~' .' •.. , · As a practical matt~~\~a~W,ith·~O.f\1§..wi'fcurrence, there were to be two sizes of confinem;~!·l?oi~s·: · Cpnfi~!P.~t i;fh~b.Ylously described larger b~x would be limited to 8 ho]&.s·(and no'mor~ than 1<8~1}.~µrs total in a 24 hour period). A much smaller oox a!so,\V~~~~~: built, nieas~~g ~ x 21 ''x 30". Confinement in this box would be " '· ' . \· t . \ '~/ CTC described·J~°)n as a "S~~ interrogation specialist" experienced "in the techniques of confrontational interrogitions:·~ · . 25 ••.......:...._...,.;,/' . . Alfred McCoy, a profe~s9r of history of some note later claimed in A Question of Torture (REF) that the CIA approach to interrogation reflected an internal program extending back to the 1950s. Agency interest in interrogation did begin very early, and continued into the early Eighties, but was not a direct antecedent of the 2002 CTC approach, which came directly from Jessen and Mitchell's SERE experience. Both SERE and initial Agency thinking, however, drew on the same early Agency and military-funded studies. The early research was summarized in Albert D. Biderman and Herbert Zimmer, eds., The Manipulation of Human Behavior(New York, Wiley & Sons, 1961), with which Jessen and Mitchell were familiar. Their conceptual framework relied heavily on the Biderman chapter by Lawrence Hinkle on ''The physiological state of the interrogation subject as it affects brain function." Both Biderman and Hinkle had received MKULTRA support. For McCoy's perspective, see Alfred W. McKay, A Question of Torture: CIA Interrogation, from the Cold War to the War on Terror (New York: Metropolitan Books/Henry Holt and Co., 2006). McCoy occupies a named chair at the University of Wisconsin-Madison. 24 ' 14 llP r(b)(1) SEC!t!!'f I IL(b )(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct , TOP SECREI/ ~-~ /NOFORI'l//IOIR (b)(3) NatSecAct limited to two hours. 26 Care was to be taken not to force AZ's legs into a position that would compromise wound healing. In actual practice, the larger box was used in an upright position, through its dimensions were such that AZ (who was quite flexible), could sit down ifhe chose, albeit in a cramped position; even the small box accommodated a squatting position sometimes adopted by AZ on his own volition. At the planned point of peak interrogational intensity, waterboard applications would be alternated with use of the confinement boxes (in which he would "contemplate his situation") until, it was hoped, "fear and despair" led to cooperation. 27 accomn~~gency OTS psychologists prepared briefing papers to request to DoJ seeking an opinion on whether the SERE-techniques .~iij,1,~ally be used in an actual in~errogation. Of the possible measures, only the ~ateroo~~·:~d I?ock ~urial . were beheved by the Agency's Office of General C01µ1~el({OGC) to-..rs.qurre pnor Department of Justice (DoJ) approval. However, t~1f ''Eilhabced Intlfeg~ion Techniques~· (EITs) initially were proposed: attention gr~p, walling te~·que, facial hold, facia.l or.insult slap, crampe? co~finem~nt.:~~~-es, wal~andin~, stre~:lft,'sttions, sleep depnvation, waterboard ("h1stoncally the mos~ectwe t~chmque us~ by the U.S. military"), and mock burials. To these was added thel'l~ment of harmless insects in the confinement box (based on AZ's apparent discomfd!\~i~ insects). After preHminary discussion with the Department of Justice, m~k-:burial had been eliminated· from consideration. Of specific interest..was.vyhether any of these· measures were barred by the most relevant Federal torture ·stan.ite,whic§'.Pr:~bi 'ted the intentional infliction of 28 severe physical or men~~IJ...~r sufferin~g .. · /y"'~..v... .. /J'.:.( ,.~ ~,-·~.. Among the ~tetjl,s forwarded to DoJ along with the request was a 24 July 2002 OTS paper on "Ps}clret~·~~al ~·~~s E.mploy~~f~e Statuto!Y Prohi~ition on To~re," a memorandum from the"~Ir·.f9r~:.9u.~f. g_f P.~ychology Services, Major Jerald Ognsseg, the Air Ro"i'ee e:K!Eerience .with SERE;·alufan OTS-prepared AZ psychological A" . .assessmeef. AccorHing to Ogri~~~g. almost 27,000 students had undergone Air Force SER@ · ing between 119.92 and~~.01:;,ofwhich only 0.14% had been pulled for psycho ·~.fill reasons (an~l~lwhi~hifoone were known to have had "any long-tem'l psychologiea:JJ~pact"). ~.:dOTS paper. assessed the relative risk of the various techniques, an'~ed jiat While they had been administered to volunteers "in a harmless way, witli · o measurable impact on the psyche of the volunteer, we do not believe we can ass .e tlt~ame for aman ... forced through these processes .... The on (b)(1) (b )(3) NatSecAct6 This small box was n{i much smaller than boxes occa~ionally used in Agency exfiltrations a decade and (b )( 1) more earlier (b )(3) NatSecAct 27 The guotat~io-ns~in-t~h1~.s-an-d~th~.e-.p-rec-ed~in~g-par_a_g_ra_p~h_ar_e~fr~o~man outgoing ca~le, from ALEC to 19 July 2002, outhnmg the proposed plan. The CTC/Legal analysis was presented to the Legal I ( b) ( 1) (b )( ) NatSecAct 3 Adviser to the NSC, and the DOJ Office of Legal Counsel, and Criminal Division; it also was briefed to the Counsel to the President. See CTC/Legal tol ~5 July 2007. · 28 A DOJ review of the use cif mock burials would have been much more time-consuming than what was needed for the other measures. Some of this history is found in Office of the Inspector General; "Counterterrorism Detention and Interrogation Activities (September 2001 - October 2003)," 7 May 2004, pp. 13-15. . 15 · r(b)(1) 'IT'l"l'D'p---.s~E~c""l!!r~chniques inflicts such pain." These exphc1tly mcluded slaP,s · allmg, stress pos1t1ons; confinement boxes, sleep . deprivation, and the w.aterboar " .. or did the. waterboard legally "inflict severe [physical] suffering," beca_us~ it '.\~~imply a c~ntrolled ·~qut~ episode, lacking the connotation of. a protracted penod of time generally given to suffenng."30 .' ... .,. •:',\ .::·~.-:/ . JY"fth r~g~d-:'t~~~~ther ~~c~iques inflicted severe mental pai~, DoJ wrote that JS:.~-~ prohibited b}1itatute they+..\v!!mld have to cause "prolonged mental harm," "disrupt profoundly the s:~s or tp'f'Personality" (i.e., through the administration of a "mind-alteriil,g_~ubstance procedure") or threaten imminent death. With the exception of the waterbo~d ,(and mock burial, which had been dropped from CQnsideration), none of the techniquel~th~efore was prohibited. "Although the waterboard constitutes a threat of imminent death," the SERE record indicated that it did not cause the requisite or 29 OMS was not part ofthe preparation of these papers and first saw them the following spring, 2003. The DoJ August 1, 2002 memorandum on "Interrogatfon of al Qaeda Operative," which ~as provided to OMS in summer 2002, did quote or summarize some portions of the OTS-prepared material. 30 Memorandum for John Rizzo, Acting General Counsel of the Central Intelligence Agency, "Interrogation of al Qaeda Operative," 1 August 2002. A separate, unclassified memo that date, stated, "Physical pain amounting to torture must be equivalent in intensity to the pain accompanying serious physical injury, such as organ failure, impairment of bodily function, or even death." Legal Memorandum, Re: Standards of Conduct for Interrogation under 18 U.S.C. 2340-2340A (1August2002), in Office of the Inspector General, "Counterterrorism Detention and Interrogation Activities (September 2001 - October 2003)," 7 May 2004, p. 19. 16 llP (b)(1) SEC!t!!l' I [ (b )(3) NatSecAct \\ Approved for Release: 2018/08/13 C06541727 t . C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) 'f'6E1 !!!CRE I Nat~ecAct I'/ MO'.ti'O!m/,,I MR / J (b)(3) NatSecAct "prolonged mental harm, ... e.g., mental harm lasting months or years." Thus the use of this procedure ''would not constitute torhtre within the meaning of the statute." 31 1 (b )( ) S · With both definitive DoJ legal guidance and White House concurrence in hand, 3 (b)( ) Nat ecAct on August 3rd the field was cabled approval to proceed. Notwithstanding the reported safety of the SERE measures, OMS believed the presence of both a physician and the PA was warranted, at least during waterboard applications. In anticipation ofDoJ approval, (b)( 1) two RMOs had been asked if they were willing to participate, and both agreed. In early 2 (b)(3) NatSecAct Jul~ ~O, en route to a temporary assi~~tl was met and briefed at Dulles Airport. At the end of July, upon ora}'apprdval from DoJ (and to await th{~r:itten approval. At (b )( 1) the White House), he was dispatched (b)(3) NatSecAct IRMO reconfirmed AZ's basit'goo(;l health, and reported to O~~ a local belief that t~e enhanced measures wou~~,:~~~~ed within 72-96 hours, i.e., ~O, who had w1thm the length of a typical SE~ program. Aft~(a week thel 1 (b)( ) accompanied the initial AZ rendition, was to rel"e;ve this RMO; he, too, was.brought to 3 (.bH ) NatSecAct Washington for a briefing. . . . ~ · 1 1 I ·tJ" During the upcoming period of intense interrogaJfon, was to be ~ven the impression that he could not escape i~ alleged neeCl~;l care. Medical attendants would no longer dress his wy,\md;-:-r~ther, a guarH 0ecas1 nally left dressings and antisepti~s _with ~hich he was to taR~~f~+.~~lf. In IJ.fiial fact, this "gu~d" was a PA or phys1c1an (with face covered, as were all1~fi~ .guat:ds),•who carefully momtored the wound, and made any~r:i..~~sary cuts o~tve:f~pe ·as-~~:i6ok care of the dressing. AZ ·~~ -....:...\ ·~· ... ,-;· ~~ Ill£~.:*~~~/ .7_!~:;;, ( '~ ~~·~· ·. ·.·. Memorandum for Jo~ Rizzo, Acting General Counsel of the Central Intelligence Agency, "Interrogation of al Qaeda Operative," 1 August 2002. In the separate unclassified memo of that date, DoJ also wrote, "For purely mental pain or suffering to amount to torture under Section 2340, it must result in significant psychological harm of significant duration, e.g., lasting for months or even years." Legal Memorandum, Re: Standards of Conduct for Interrogation under 18 U.S.C. 2340-2340A {l August 2002), in Office of the Inspector General, "Counterterrorism Detention and Interrogation Activities (September 2001 - October 31 12003\ " 7 M~ 2004 n 10 . ll ~~ ~ ~ NatSecAct 17 'f'oF sEeRE'l' / r(b )( 1) ~-----{~(b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'feP SEe!tET I J l/MOfi'O~//l'm: (b)(3) NatSecAct Initiation of "Enhanced Interrogation Techniques" (EIT's) On August 4th, "enhanced interrogation techniques" were begun. Within six hours these progressed from attention slaps and walling to confinement in both the large (about 5 hours) and small (about 1 hour) boxes, and finally to the water board. The initial waterboard sessions lasted about two hours, although with significant breaks and with no single application exceeding 17 seconds; and none exceeding 30 seconds in a later second session. 33 After a final half-hour in the small box.Pas left overnight in the large box. Medical-which remained continuously on-sii-u~out the intense phase of interrogation-monitored AZ's condition throll;gQ((ut th."'e.rught via a grainy video feed from inside the box. The next day, 5 Augw;t, was suJ?je~ted to a similar course. Neither day produced notable intelligence~~pit~willin~~!o give other 'wz kinds of information, AZ was sticking to his p~ous stat~ent Iha! bO'~osed what httle he knew on 1mmment threats. Infqrm~l\iY...._the ~Q wrote that ~~."seems amazingly resistant to the waterboard" and was "be~2~.i9-g,habj,tuated to th~ ooxes." Contrary to expectations, the process was going to tak~· long time." The whole experience, the RMO added, was "visually and psychoiogicapy very uncomfortable" for all those witnessing it. 34 · · .. .·. ... , ·,/ EITs continued to be applied witli :v.arying C:l~&fe~ o(i~tensity until the morning of 8 August, when a partj~td,~!Y aggressive sestion left'IZ!highly distraught, and some of the on-site staff pr9~6undlx ~f-f~cted. In tfi-iwake, the~n-site personnel concluded the intense phase should~ni:,t be co'n~ii)ued much fiirther, and that senior CTC personnel needed to see the j:>ro~~t h~~. The sam_e\r.atocols noneth~less were _continued for the next few days, as pl~n~~e:·m:aete :fQr~_y1d~-teleconference (VTC) with "a .,~7 headqu~ m~i:-1 ro1eiieg&Il.,..to include staff counseling." (b)(3) CIAAct (b)(6) A@n August 13th~~~VTC'W.as.J;teld, including video clips from the full range of · ~ efforts. 1---R~ L___JJ~~ was pne of those in attendance. Despite a grainy appearanc~~ntensity ~,,.le ongoing interaction was graphically evident. .CTC analysts, howe~maitjconvinced that AZ had detailed time-perishable information, ~ interroga~ien 33 The waterboard was~ed slightly head down-as was done in SERE-and included a capability to (b )( 1) quickly pivot to a verticaiifosition to facilitate clearing the air passages. 33 The medical team had limited (b)(3) NatSecAct AZ to liquids for severalhours preceding this exposure, but when his anticipated vomiting included solids from early that morning, he was restricted to liquids only for the duration of the intense phase. , 34 Lotus Note,c:::=J Medic toL}1S, 5 August 2002, SECRET . 33 Thought was given locally to bringing in a staff psychologist or psychiatrist to work with the staff. The (b)(3) CIAAct on-site OTS personnel objected to this, a reflection of long-standing antipathy between OMS and OTS on (b)(6) the psychology side, and an OTS belief that they should control all "operational psychology." As these were potentially staff consultations, this argument wasn't accepted. However, it was decide that a more ( b) ( 1) practical approach was to have OMS staff evaluate/counsel all staff personnel on their return from (b )(3) NatSecAct and psychologically prescreen anyone being sent out(b')( )=::::Jor other future detention 1 sites). (b)(3) NatSecAct 18 f(b)(1) I, !OP S!!!CltE'f/ 4-(b)(3) NatSecAct----__J-r·l_~e_F_e___,R:H I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct TOP SECREI/ /NOFORN//MR (b)(3) NatSecAct which warranted a continuation of the process. 36 Given the on-site OTS psychologist assessment that AZ's psychological status was fundamentally sound, and the RMO's37 judgment that the wound still looked acceptable (albeit at some risk if the process continued another two weeks), C/CTC directed the enhanced interrogations to continue. However, to allow AZ more opportunity to cooperate, the breadth of questioning was to be broadened considerably; and all decisions on.technique left to t}Jose at site. Enhanced measures continued for the next ten days, albeit at a much lower intensity. The waterboard was applied on only two of those da~('~gust 15 and 19), and for the final three days the small confinement box was not us~y-Even·this limited waterboard use was meant only as a brief reminder when ~af?Reared to be backsliding. sessipns~~ti~sed Between these final two waterboard by the field about the possible use of a medical "disinhibitor," sucli as.sodium am~ •..which prompted another OMS review of "truth serums.lsuch drugs, although!'hnued with the new !me of 8 question made new measures unnecessary/ ··<:.t:·:-.~.. ~ COOT}' V·. , " ·., .. Medically, AZ sl"!~:W~/emarkable\~~~~1i6nc~'tfu:'9~~out the process, in part due to a manifest concern. f9r:his:o~~ .. physical W.~Jl-being. The early worry that he would .~ " ' .. attempt to aggravate'l»!> woun pecially whtl,e in the confinement boxes, proved . entirely unfounded.· H~'~ays s very attentiv~ to his dressings. The boxes themselves eventually seellJit · e as an escape from more severe measures. Dunng the most P.~Y,$i~!:'Ph~.e oft~~ ,mterrogation;. wound healing did slow, and eventually . there Waf!'fuinimaJ deteijorat~n'. of ~ome margins. No signs of infection presented, hOW).Me~d the intenSf\:.:pi_ase o'f"the interrogation ended before further deterioration would Have forced medicfilaintervef.i.tion. "· .•. ' " ~#' 'ft"\..( 1 (b )( 1) (b )(3) NatSecAct ounri~t?..final, trari~ition phase of enhanced interrogation (which began on August 19th and\m,_deq th.~.:23ni), AZ was in an increasingly benign environment. This allowed solid food;' &'eatly improved hygiene, and the resumption of more active medical care. The edges ofty1r'wound quickly recovered, and the healing in of the basic defect resumed. When AZ entered the "debriefing" mode, both the RMO and the PA were able to depart, replaced-as previously-by headquarters-based nurses, who attended to the healing leg wound: 36 On-site personnel came to believe that Headluarters thought the field had lost its objectivity. . By this time ~O had replaced 38 Another question raised was whether a small· amount of shrapnel, still imbedded in his parietal lobe after a war injury some years earlier, could explain his failure to recall certain details. Our consultants judged not. 37 b) ( ) ( 1 (b)(3) NatSecAct I IRMo. 19 [(b)(1) ~ TOP SEeRE!'f/ 'L(b)(3) NatSecAct----__J--rr_te_l"'_e___,!tM' I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) (b )( 1) (b)(3) NatSecAct Nat~ecAct 'f6F :31!!C!t'.EI I /MOPO!tM//Mit (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct Within two weeks questions about AZ's candor again were raised and (b )( 1) RMO was sent for against the possible resumption of more intense methods. ~E_nh_an-ce_d_ (b)(3) NatSecAct methods proved unnecessary, but during th~ IRMO's weeklong stay at · I Ithe RMO flew down to be briefed into the program. To further build the support cadre, th~(b )( 1) RMO was recalled to ·headquarters for the same briefing. . (b)(3) NatSecAct 1 (b )( ) On RMO returned! lthe U.S. raised 3 .. -h-i- closed)Hirieen embassies and (b)( ) NatSecAct its terror alert level to "orana:~ ~c_o_ns_u_la_tes_._ _ _ _ _ _ _ (b)(1 )_ _ _ _ _ _ _ _ _ _ _ _ _ _____, (b)(1) r (b)(3) NatSecAct (b)(3) NatSecAct _ _ _ _ No attacks materialized, but the anxiety level iemained higli. lf.l the_ Washington, D. C. area, five separate "sniper.;46ks the fir.st week in Octer left five random Washington area residents dead-all kill~'tstth~f!t about routine daily activities. For three difficult weeks, until the killers w~aptured, the sniper attacks were believed by some to be another··ten:~rist assault. ~mitlst this local angst, on Oct~ber. l21h, the al-Qa'ida-affiliated JI bombed.. a.#i~i~lub in Bal~~ip.g_202 people. · (b)(1) .. _,,_ ..~... ___.,·.'-.... (b )(3) NatSecAct Amidst these ongoing developm~ri~~· t~~::otii.¥1:..;~~-!~ value targe~s" .(H~s) were captured wh!l eventu~lly ":~lJ.j.g be hande~ ·>,-;~» -.:·.~ ·.'~ ~ (b )( 1) (b)(3) NatSecAct 23 'fOF. SEl~'f/ [(b)(1) j VNGFGR!l (b)(3) NatSecAct I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)~;:$) Nat~ecAct ~OF SECHT/ J l/M8P81tM//:Mit (b)(3) NatSecAct The question ofdrug-assisted interrogation The intensity and duration of AZ's interrogation came as a surprise to OMS and prompted further study of the.seemingly more benign alternative of drug-based interviews. 48 The only readily accessible summary of the Agency's extensive early · experience was a spring 1961 Studies in Intelligence article, "'Truth' Drugs in Interrogation," which had concluded, No such magic brew as the popular notion oftru~hfe~m exists. The barbiturates, by disrupting defensive patterns, may sometimes be helpful in interrogation, but even under the best conditions th~~!l elicit an output contaminated by deception, fantasy, garbled spe)i"ret~major vulnerability they produce in the subject is a ten~ency to ~~ he has revealed more than he has. It is possible, ho.wever, for both norm.al individuals and psychopaths to resist drug interrogation; it seerri!likc;:Jy that any individual who can withstand ordjrf~iptensi~ tnterrogation\~,.'l(o'td • . 49 . ~.·>.. r out m narcosis. ~rr,f:, ·-..,,.." .' · This wasn't necessarily the final .word, however, ·e;V.:en in 1961; Technical Services Division (TSO, predecessor tQ OTS). was in fact ~g ~rugs in interrogation about that time (notably LSD)~~~ULTRA ~-g research continued at least two more years. Addi~,any;,~e~.§.~ f.C.UBARK {CIA) Counterintelligence Interro.ga#on manual, sti}.!}ihcludoo:~drugs among the potentially useful int~rr6gati6~}!.Q.ols, if only.for a placebo effect, or to allow the subject to rationali~t(gi~ing up':-irtformation. so·~,. .:· -..,.- .• ·, t ~ ,I An OMS staff,~sy~hiatrls~:pbt~i~ed fro~ the DO's Central Eurasian Division a compilat~~e'f~'"efin! oii-~e so.vlef'd~!fptogram. OMS was aw~e that studies of commumst "bram wasliing" tecltAiques m the 1950s and 1960s had concluded that Sov!s,t.ellite, and C~i'fese sucGesseiat "mind control" were achieved without the use ..... ~ ---~=------~.... ,.~/ . i")' 48 Similar thifilffiig was partiall onsibJe for interest in the use of"truth serums" in the 1930s; they avoided the more P.h:r.sical measures then in use by some police departments. 49 George Binnmer:Ie • ruth' ~gs in Interrogation," Studies in Intelligence 5(2):Al-A19 (Spring 1961). ,\i.~ym for a TSO/Behavioral Activities Branch (BAB) non-scientist working Geroge Bimmerle principally as a researc writer, but once involved in surreptitious LSD administration. This article apparently was prepared~with help from Dr. Edward Pelikan, a consultant pharmacologist formerly on the Technical Services Staff(TSS, predecessor to TSD). In 1977 the Agency introduced the text ofthis article, without title, author, date or sourcing into Congressional Hearings on MKULTRA, as a statement of then current thinking on drugs in interrogation. LSD received only the passing comment that "information obtained from a person in a psychotic drug state would be unrealistic, bizarre, and extremely difficult to assess... Conceivably, on the other hand, an adversary service could use such drugs to produce anxiety or terror medically unsophisticated subjects unable to distinguish drug-induced psychosis from actual insanity." so KUBARK Counterintelligence Inter~ogation ( 1963 ), 99. 131 ( SECRET). While no author is listed, the manual was prepared by or jointly with the TSD/BAB psychology staff. A redacted version of this manual was released to the public in 1997. m 24 ':POP SEgRi:T/ ,r(b)( 1) ----,I t!l9F9Rl1 ~---~(b)(3) NatSecAct----j--, Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'fOP SECREl/J IJNOFORN//MR (b)(3) NatSecAct of drugs. The 2002 CE data was consistent with this, in suggesting that the most intense period of Soviet drug study had not come until the 1980s, in the wake of intense 1970's publicity surrounding the Agency's drug programs. It appeared that the Soviets had looked into drugs similar to those once investigated by the CJ.A. and U.S. military (e.g., psychotomimetics, barbiturates), and-as in the U.S.-had failed to find any particularly useful drug. 51 . The issue of drug-based interrogation vs. SERE techniques was discussed with three OMS field-based psychiatrists at a Mental Health Division ~MHD) field conference the first of October. All had peen exposed to amytal intervie'Js'd~ng their residency training or later, typically treating hysterical paralysis. Th~g~cfl. ~f the interviews had not ' been to establish actual facts, but rather to seek the "psy~q&fo~al'.~th" behind the condition. The psychiatrists, while not optimistic, t~yglit~hat gi\~~ ·the alternatives the subject was worth more study. A long distance dialog\l&icohtinued for Uw next 2-3 months, while each did his literature review, andfs'!bmitted thoughts. "-:~~~ , ~ ~.,, "'-.;.,· -· Eventually it was decided that the most promi'singJPprqach would b~ong the lines of traditional "narco-analysis." Unquestionabij!~Me false infonnation would result, as was the case with more physic~l methods, bu'?t't!1's~wasn't necessarily a sh.owstopper. Even the unreliable barbj~\< j.nterviews o'f~~Os, in the hands of sophisticated analysts, sometimes providect·us.~ful·l.eads. '\ ·--...: ~ ~- ..... \n., /· """":. ·,· :· •. - ·:> . The preferred drug.'.ap.geared to be mi.da'Zalam"l~ers~). a comparatively new benzodiazepine. Ver~iw~~~of the saf~~t.:~d most.easily reversed benzodiaz~pines, and clearly much P,referable to tl'ie older barb1tµrates. It also afforded some amnesia, a sometimes desiralfle s~ary ftect. A dowrlsid·ewas a requirement for (presumably) physician-assi_sted intra enous&irust~~~~-l~'hich decades before had been an argument .!igl!in$t'barbiturate ·. terr~s-:;... vice LSD which could be administered "silentl):;;'.'.. .. · · . ': · ;}~ '~:ti" A~~bivalently, V~ was j<>nsidered possibly worth a trial if unequivocal legal sanction first\vEre obtainet!....;There were at least two legal obstacles: a prohibition against medie?ift~,{>eriment~tion on prisoners, and a ban on interrogational use of"mind~tering drugs" ~r~~~~ ~Jii'ch "profoundly altered the senses." The latter seemed clearly aimed at hallucmoge.ps}1K:e LSD (a legacy ofMKULTRA), but the legal status of more traditional "truth serpn'ls" was not clear beyond the inadmissibility in court of infonnation obtained under their influence. The question became moot, since CTC/LGL did not want to raise another issued with the Department of Justice. 51 "Drug Assisted Interviews," 10 September 2002, (SECRET) Several years later, a laborious review of Agency archival matenals made possible the reconstruction of much of the early record on drug-assisted interrogation. This clarified the actual practice and conclusions at the time, but did not identify any particularly useful technique. · 25 '!'"""" s:ce=cro/ [(b )( 1) l/"l9n9m1 o~?~L--ro:;--~--(b_)_(3_)_N_a_ts_e_cA_c_t~~~~-r-~~~~-T' Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 1!9P SBCR:E'f I j I /HOFORM;' ;'HR: (b)(3) NatSecAct At the beginning of2003 the OMS review (informally termed "Project Medication") was shelved, never to be reactivated. In retrospect, even had there been legal sanction, an opportunity to try drug-assisted interrogation may never have presented. An interrogation of the intensity o.fthe AZ case was repeatM only once thereafter, in a particularly high profile case; in all other cases, less robust methods seemed adequate. As OMS gained more familiarity with successful interrogation, another drawback to the use of a drug like Versed became evident. As a measure of accountability, coercive measures were increased when detainees intentionally provided provably false i11-formation. A detainee speaking under the influe11q:~ of drugs, however, /~., could credibly claim ignorance of anything he had said. /~.~._ ~::~ Failure to pursue the option of drug-assisted interr6gatio~o spared OMS physicians some significant ethical concerns. Throughorlt~t.ts sup'f,af:t~ofthe RDG program, OMS scrupulously avoided involuntarilY. aktihg detai~s!'ol.. With rare exception, detainee treatment was given only afte~rst obtaining conse~~~:f~~,sed, the treatment was not given. sz Though perhaps qn~lo/., it w~411-ossible that soBjtC'V'detainees would consent to a drug-assisted interview-to ·~~~~ lli~y were not withholding: information. {This sometimes had been the case in oe.~~lice and early Ag~ncy use of the historic truth drugs.) Whether or(µot_consent was oo~Q.¢, drug administrationpresumab_ly by a·physician-clearly wo-q.!#·-ha~~ been an ~~j·~~-procedure for nontherapeubc reasons.51 . . \·'~. y , Notwithstanding.J~r3:~tual record, 1~~903 a det4¥but imaginary account was published of Agency Jl\lfadicat per~onnel usirlg: Sodium Pentothal on Abu Zubaydah, who "evidently [was] their.st to be.given thiopentatsodium."54 Remarkably, this claim was ·rarely if ever repe!ile'J~:·>vµen t1le·opportunity i~terpresented to discuss interrogation. techniques with a Congressional Committ~~. the· Agency was asked why it had not used drugs. ~~WS:~Otdiugs dort'tWoik-"which is true, probably. ss A,il" 52 i'' Oii~e ~!id ...... d~~~tive i~d~~~J~:ls sedated~nce violently been during a rendition, and once in. :elf-harm ci~ endanglrment to ~thers: A f~w detainees on hunger strikes were mvolUntanly feCI lliiough a NG t}l:l;>e, but always with their assistance. 53 When first discussed, the pe~tifutl ethics of some of th~ physician staff probably would have allowed participation in legal! ... · ie~ drug-assisted interrogations, as a more benign alternative to the very aggressive approach be1 ployed. When waterboard use effectively ended after March 2003, the eftical equation may we,!1 liave changed. . . ' 5 Gerald Posner, Why America Slept: The Failure to Prevent 9111 (New York: Random House, 2003, pp. 187-188. Posner also claimed,'incorrectly, that Zubaydah,was hooked to a polygraph during this time. ss Several years later, a laborious review of Agency archival materials allowed a reconstruction of much of the early record on drug-assisted interrogation, which clarified the actual practice but did not identify any particularly useful techniques; Both barbiturates and hallucinogens seemingly had produced compliance or µseful reporting in some cases, but this was against a backdrop of confabulations or deliberate misreports. For bureaucratic reasons as much as anything, LSD eventually displaced the conventional medical use of barbiturates in interrogation. Given LSD's associated medical risks and emerging societal strictures, its use later was abandoned. Objectively, aside from ease of administration it offered no more than the .!>arbiturates beyond scaring some into cooperation. ~etentio~to; 26 'XQP Si'CPFT/ f(b)(1) ~--_____,l(b)(3) NatSecAct VNOFOPN I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct \./ 'i'O!I S!!:CRE I 11 r /HO!' om//1'?.R ·~I~~~(_b)_(3_)_N_a_tS_e_cA_c_t~~~The Role ofPsychologists and Psychiatrists The AZ interrogations highlighted just how challenging ·the emotional context would be, both for detainee and those present. As a result, in mid-August 2002 MHD began a debriefing assessment of all employees returning from detention sites, and by month's end was screening all those being assigned to these sites. When an interrogator training program was begun in November, candidates first had. to be evaluated by MHD. ~~~g~ NatSecAct MHD (and the OMS front office) also began quiet inquiri,~nto the philosophy and operation of existing SERE programs. In early Novemb~~ERE psychologist assigned to the Army's Fort Bragg program spoke to an OMS MHD detailing.the specifics of their training. The Bragg program made aggrers'ive use offlte same techniques used against AZ (other than the waterboard,) ~1t also for~d trainees into a cold outdoor pool (eve~ in winter). The role ofth~ho~~s~ anJimary ~~etage and coordinate the support of other OMS (b)(3) CIAAct psy6iologists and psychfii~sts. By•2oo~ IOMS psychologists and L(b)(3) CIAAct psychiatri~\J!frovided~me support· to the program. (b)(3) CIAAct Q~n.'s.slif!~O~o~ the contract p~ychologist/interrog~tors was attributable to (b)(6) . their bemg v1ewed~the'Agency's most skilled and successful mterrogators and . indispensable to wh~t;was emerging as the Agency's most_ productive counter-terrorist program-alone accounting for over half of all al-Qa'ida-related intelligence. So highly regarded were these contractors that they commanded ready entree to the Agency's most . 59 Ethical Standard 3:05 Multiple Relationships. . Beyond its intrinsic value, this participation addressed a lingering question about OMS involvement in the interrogation program. Amidst the January 2003 OMS-OTS tensions surrounding ethics and coverage, OTS had announced a "requirement" that fonnal SERE training would be prerequisite to serving as a "Special Mission" psychologists. While not enforced by CTC, the lack of OMS SERE experience was a recurring OTS theme until summ~r 2003. 60 29 '3?0P SESRl!:T/ /l(b)( 1) . l:NQP9Jm ~--~(b)(3) NatSecAct----~- Approved for Release: 2018/08/13 C06541727 1 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) 'f8P Nat~ecAct :!~Cr<'.El I I I /NO!i'Ofm//ltftt (b)(3) NatSecAct senior management and four times the compensation of other interrogators. Given this, (b)(3) CIAA~SMD still sought opportunities to further utilize their services as psychologists. Over (b)(6) the next year, this infrequently generated tasking to psychologically evaluate those they once had interrogated. Each time OMS objected, reluctantly agreeing that the contract psychologist/interrogators could possibly perform assessments without conflicting interests on those with whom they had had no dealings as interrogators. The OMS preferred solution was that these contractors choose one role or the other, not both. In May 2004 the first Inspector General report on the interrogation and detention program reviewed this history, noted the eontinuing OMS concerns and foFiilally recommended a policy that "individuals assessing the medical/psychological et'f~~EITs may not also be involved in the application of those techniques." 61 The n~n of "psychologist/interrogators" then disappeared, and the s&tE' ri&""tifi:actors worked solely er reviewing the on the interrogation side. 62 1J'iat summer the Departm~f"Qf Justi · JG report, asked OMS if the problem had been res~ved; and OMS ~~'l~. could agree that it had. ,_.#' . " ,,. ,. 't·. ~·, ..s~·" An early task of the OMS psychologist detail~ to ..~-CiJ, was the creation of relevant standard operating procedures (SOPs). By D~~eniber 2003, and with the input of o~~r ~M~ psychologists, this had,~wn into' exten;~ guidance ~or p~ychologists part1c1patmg m the RDG program. Spec1licaJly addressed wel\e Quahficatlons and Training; Psychological Support to Inteq~gati~ pebriefing~St~dards of Care; Guidance and Definitions For Mental Health Asses~ent of CIA Detainees (including a · requirement for daily asse~sm~nt during erlhanc:l m~~1frts~ Psychological Distur~ance; Assess~e~cff.'.IB:fig-term Funcii?nin~ andJrMental S~atus; Stan~ard . Operatmg Procedures for Mental Health EmeF.genc1es; PIA Interview (a pre-mterrogatton face-to-face intervi'e\v~~ssing,sychological ~~oility, mental status, resistance posture, and suitability for enharited..mea8iires);.and evJ/r Cable Format. An appendix addressed "Ethical Stan1iai:'1s fer Psy'chg{~;tsPioV.iajdg Support to CTC/RDG Operations," which was ad~~tea from ;w~·· 2002·~~ical Principles of Psychologists and Code of Co~ ·\.~-/ _ _-~~chologiststnoneth~less sometimes found themselves operating in a gray zone, as they ~ltemated befeen operational and clinical roles in supporting the program. They assessed ~tal status and monitored psychological well-being, but also looked for any apparent factors\tii~ would preclude the use of enhanced interrogation techniques (e.g., a,history of ab~e or some significant psycholOgical problem). If enhanced measures were employed, the psychologist reassessed the detainee's psychological state 61 Office of the Inspector General, "Counterterrorism Detention and Interrogation Activities {September 2001 - October 2003)," 7 May 2004, p. 35, 106. 62 Eventually allowing their psychology licenses to lapse, Jessen and Mitchell launched a very successful business-Mitchell, Jessen and Associates--which provided guards, interrogators, and debriefers to the CTC program. 63 "Psychological and Psychiatric Support to Detainee Interrogations," in draft, 10 December 2003. [14 pp + 9 pp appendix · 30 'feP SI3CRE'i'/ n~~g~ NatSecAct kuopo;ffi1 I Approved for Release: 2018/08/13 C06541727 1 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct '£OP S:Ee1':l!'!T/ j l/H8F81tti//flR: (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct on a daily basis. While never recommending specific coercive measures (e.g., on the basis of perceived vulnerabilities), they did make recommendations on positive incentives for cooperation (e.g., playing to a narcissistic ego, or providing extra social contact in those for whom socialization seemed exceptionally important). This nonetheless was an uncomfortable, somewhat dual n,>le. Thought was given to establishing separate operational and clinical teams to handle these two dimensions, (b )( 1) (b)(3) NatSecAct but there never were enough resources, and with the passage of time the issue was resolved by the disappearance of subjects for aggressive interrogatio,Il. In 2005, the AP A first addressed the national security context, but by then the is~.9Pwas'.4argely moot. (See (b )( 1) the discussion under Exposes and Ethics.) Initial psychologi'€ll~-:assessments of potential (b)(3) NatSecAct candidat~s (most never slbjeyed to EITs) had fall.en from'{er~ii~:Qin ~003, tq number m 2004, to about m 2005, and m ?OO,~etamee,_~,·~}!bJected to_ __ enhanced measures declined fromQn 2003, to ·:2004, an<(]in 2©~.~.. After 2004, at (b )( 1) least 97-98% of the work was purely clinical, int e form of quarterly merit~~ he~lth (b)(3) NatSecAct clinical visits-by ~ither a psychol~gists or a,p~~atrist~ . . l~eta~es in as many locations. As a practical matter, the-auaI operati9nal-chmcal~role had all but disappeared. ~'.:, ""'~;·~-- (b )( 1) (b)(1 )·' · ~;· (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct . (b)(3) NatSecAct. .,;~~ ~:(b )( 1) . ~ ,~···f.~ ';::~"'. (b)(3) NatSecAct (b)(1) ... (b)(3) NatSecAct,~ ':'\ ... - -If'··. •• 31 'fOP SEEJRi:T / {(b )( 1) rNO:M:O:R:ff ~--~(b)(3) NatSecAct----~- Approved for Release: 2018/08/13 C06541727 1 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'fep· :!ECREI/ J . l/NOFOF \ intervened, and the maneuver was not repeated#··f$.eeks;later a debriefer, absent the interrogation team and Pf\, rei:nstated sleep~rivation; ~tried to intimidate Nashiri by hooding him, spinning the):ria,gazine of a ·revolver, arid starting up a power drill (albeit not actually touchim(fu.e detai~}. These actions led to disciplinary measures. 64 a~l ~; :~~~ dL1ees ])~k o~erseen (b )( 1 ) . . .. Not were these carefully RG HVT (b)(3) NatSecActfac1hhes. M'aIJ.Y.:,~-£Cted te~~~sts were rounded up dunng m1htary action m I ~~me of potential-.fil!~lligence value. I (b )( 1) (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct---------------------~ . , ~lso had no written interrogation guidelines, though early on was I granted permission to employ sleep deprivation, soli~ary confinement, nois~, and 64 Office of the Inspector General, "Counterterrorism Detention• and Interrogation Activities (September 2001-0ctober 2003)," 7 May 2004, p. 41-44. Nashiri also had cigar smoke blown in his face, and may have been scrubbed with a wire brush. 32 'f9F ,f(b)(1) SBGRE1'/(b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct I. > .. 'fOP SECREl/NOP'Of~'... . . (::tlMf? ,f'~itwitions and~n~ G;,,uo pmo, the renamed RG) in D~ber was given 3 (b)( ) NatSecAct (b)(1) responsibility-l "Guidelines on Confinement Conditions for CIA Detainees" (28 January 2003) 34 "'O .I. e I r(b )( 1) 1,u809.,,n !I SE RS'f ~(b)(3) NatSecAct----~LJ:_'l_:i:--_:i:u'l I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) 'f'SP !!!!C!tE I Nat~ecAct /I f . l. /M~PO!tM//Mil (b)(3) NatSecAct • J accounts began in March 2003 with an error-filled, though widely cited New York Times piece on interrogation techniques, which included an alleged account of the interrogation at Bagram Air Base of Al-Qa'ida facilitator al-Farouq the previous summer: "[A] western intelligence official described Mr. Faruq's interrogation as 'not quite torture, but· about as close as you can get.' The official said that o~er a three-month period, the suspect was fed very little, while being subjected to sleep and light deprivation, prolonged isolat~on and room tem~eratures that varied from 100 degrees to 10 degrees. In the end he began to cooperate." 0 Perhaps because the imagined temperature range was not deemed credible, this claim was not soon repeated. (b )( 1) (b)(3) NatSecAct . . -:> The only time deliberate manipulation of cell temJefature was proposed for an RDG detainee came ~~ the~p~e ~f Kh~i~ Sheik Mohammed, the most important HVT yet taken. ~g}t not part ofDCI guidance, ''uncomfortably cool temperatures" were included in tfie ·submitted iµ,terrogation pl~; Reading this, and in view of the recent Gui Rahman experience, QMS~seFJ.~tll,«:'~l!~~n~µig medical staff some reference material, including WJ.or~oomm~'1t~.ambient temperature ranges (no lower th\11164°), optimal temperatures (78°·cloth~4~ 86° unclothed), and the "thermoneutral zone" (68-~6°) below 73 whi~h~~~ent temper_a~monito~g· was necessary. Were a deliberat~ly _cool space to be usetlj,:..~e lower hm1twas 55~fand any confinement between 55-60° hm1ted to 2-3 hours unless tfie detainee w~ free to move around or sit on a protective mat. Below an ambient templrit;:,~f 6,d~tainees were to be monitored for hypothermia. · (b)(3) CIAAct (b)(6) OcTC soo~speclfied that detention cells be maintained between 75-78°. Eventually, in June 2004, a DO review of the program noted that ''uncomfortably cool temperatures" have. "not been us.ed as part of CTC' s interrogation program," and I 70 "Questioning Terror Suspects in a Dark and Surreal World," New York Times, 9 l\1arch 2003. This also was one of the early articles to ·charge that the Agency withheld painkillers from Zubaydah. (b)(1)~---i (b)(3) NatSecAct I 35 'feF SBCRB'I'/ [~~~g~ NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'feP S!:CREl/I f /N'Ol'01m//l•m: (b)(3) NatSecAct recommended that such be deleted from the list of interrogation techniques. 74 OMS personnel confirm that temperature manipulation never became part of the ROG program,· and that no ROG detainee was exposed to extreme temperatures. When the 14 -r.emaining HVDs were transferred to Guantanamo in 2006, most reported to the ICRC that initially they were held in' cold rooms. Their perception of "cold" was primarily a reflection of personal comfort levels, and not the actual ambient temperature. 74 Memorandum for Deputy Director of Operations, "ReView of CIA Detainee Program in Response to DCI Query," 30 June 2004. 36 'l'QP S:EC~ET I f(b )( 1 ) (b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) 'fOP :3!!!e!tET Nat~ecAct !I r/Mef'efttf//I•JR (b)(3) NatSecAct I KSM and the Waterboard The 1 August 2002 DoJ approval letter had characterized the SERE waterboard process, as follows: " ... once the cloth is saturated and completely covers the mouth and nose, air flow is slightly restricted for 20 to 40 seconds due to the presenc~ of the cloth ... [This] produces the.perception of 'suffocation and incipient panic,' i.e., the perception of drowning. The indh~Qual does not breathe any water into his lungs. During those 20-40 seeb'hcfS; .water is · continuously applied from a height of twelve to twen!i~q:ur inches. After this period, the cloth is lifted and the individual is1Sowed to breathe for 'lftJi! 'v.J.~ three or four full breaths ... The procedure m.n\~e repe~: ·:." th~~'i~~~iition More broadly DoJ wrote that their generattrx'pect;pon was [of any technique, not just the waterboard] will not be~stantial because the techh1qile~ generally lose their effectiveness after several treiftrti~~t;~~,the question}df safety, DoJ had written, "You have informed us your on-si. i~~iogists, who have extensive experience with the use of the waterboard in Navy trainin,~.Qave not encountered any significant long-term consequences frol:-~~~'~;·" ~eparate~~'.9MS heard..from .ard·Q~cause tt nVproven 1mposs1ble to resist. OTS considered it the most criticai\~le~~ht .i.ii the,prQJ""am-a point, OMS later -~· learhed, explicitly made to D~J. ' ;¥ ·. · · Subsequent te the AZ interrogations, ~MS learned from medical personnel present at the time that most of~ waterboard °'applications were very brief, though som~ti~es qu~ckly repea~ed~· ili~m!~~sl\\ia8 th:J:.~fuere had ~een ab~ut ~0-40 si~ificant apphcatiofk(~I.earjftecbp1que. and expen·enc~ with that of the Agency. While no specific ·""' ~. . ·''· limits were· set on applieations·P.er. .session, it was observed that a.S many as 25 · applicati~ms probably . d be _,dunng the first week, but thereafter only sporadic . ·~ ... '11·.··· waterboat~tuse would be a~,eptable. · :·. (b)(3) CIAAct (b)(6) (b)(3) CIAAct (b)(6) ::s ~ By tht~ime OMS convinced that the Agency had been poorly served by shallow research ·~ttie w~terboard and its purported irresistibility. Additionally, OMS (and the Inspector G~n~al) heard that rather than having "extensive" experience, neither of the two psychologiftslinterrogators previously had used the waterboard; and that only one had even seen it. in use. This was consistent with their having worked in the Air l]Ms 1 tQCTC/LGL, 28 March 2003, responding to a I Icable critique of the proposed OMS Guidelines on the waterboard, which the RMO had shared with personnel. The interrogators asserted that the waterboard had been selected specifically because it did not lose effectiveness with repetitions, and that they knew of no evidence that effectiveness was loss. · 79 In late 2006 KSM reported to the ICRC that water had been poured onto a cloth by one of the guards "so that I could not breathe" and that "[t]his obviously could only be done for one or two minutes at a time." He remembered the process being repeated for about an hour. I (b )( 1) (b )(3) NatSecAct (b )( ) 1 (b )( ) NatSecAct 3 40 'f9F SECRET/ f~~~g~ NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) 'fO~ Nat~ecAct l1NvFORN//toJR (b)(3) NatSecAct SECREr/J Force SERE program, which had not used ·the waterboard for years, and seemed to explain the wide disparity between their methodology (number of repetitions, length of applications, volume of water, 80 and technique) and that described to us by the Navy. In essence, the experience with ~ and_ KSM had been little more than an amateurish experiment, with no reason at the outset to believe it would either be safe or effective. 81 \ . Some within the RDG leadership agreed with OMS on this point, and with the view that the value of the waterboard was vastly overstated; others thought the waterb~ard was key to the success of the two mo.st im~ortant in~$~a~ons in a . d~amatically successful program. In fact, after his penod of e»ancoo mterrogat10n, AZ was a remarkable intelligence resource. As ''the professor,_'.,lProvided a veritable encyclopedia of useful material. Later he attributed his ~operation to various factors, including an interrogation of such severity that it allowed"llim to;ra~alize cooperation to Allah. (He also once said he cooperated becaUSt? .of the. medical care W:ven ''to an enemy''-like his mother would have don~. H~elieved the medical statf"~t least twice · ·_;.•.,· -~, had saved his life, though noted this had den(~ him martyrdom.) .• . . ,::..· ,.· In practice; however, AZ's cooperation did notf.C<>rrelate that well with his waterboard sessions. Only when questioning changed tb~·;ubjects on which he had informatio_n (~oward the end ofw_aterbe.fF~~1'.1,~¥~) was he fo~co~ing. A psychologist/interrogator later said that wa(emoard use had established that AZ had no further information on imminent threats-a creative but.circular justification. In retrospe~t ~M~ thought ~-pzybably reach~~- poiWt1f.c'to~eration even prior to the August mstttut10n of"Fah~,measure84~ development missed because of the narrow focus of q~~~tj~ning. In any event, there was no evidence that the waterboard produced time-perishKt>ie info~a!_i_on which ot~rise would have been unobtainable. 82 ' ~toven m~:'-;;;iitent t~~ KSM his soft appearance suggested, even during the period of moi?.t intense waterboard use. He figured out early that, hpwever unp~~.t the waterb~izrexperi'e~cel"'it wasn't going to get any worse, and he knew he An averagel~five gallons pe;,J~ssion was used on KSM, some being ~plashed on his chest and abdomen. This'w~out five times the volume allowed in a SERE session (which also included splash, but was delivered ·iii"ir'single ap~lication). 81 This OMS view was well~~ through it's inclusion in the final May 2004 Inspector General Report: "According to the Chiefm~ical 'Services, OMS was neither consulted nor involved in the initial analysis of the risk and benefits qfEITs, nor provided with·the OTS report cited in the OLC opinion. In retrospect, based on the OLC extracts of the OTS report, OMS contends that the report~d sophistication of the preliminary EIT review was exaggerated, at least as it related to the waterboard, and that the power of this EIT was appreciably overstated in the report. Furthermore, OMS contends that the expertise of the SERE psychologist/interrogators on th~ waterboard was probably misrepresented at the time,'as the SERE waterboard experience is so different from the subsequl?nt Agency usage as to make it almost irrelevant. Consequently, according to OMS, there was no a priori reason to believe that applying the waterboard with the frequency or intensity with which it was used by the psychologist/interrogators was either efficacious or medially safe." OMS also thought it inappropriate that the only interrogators authorized to use the waterboard werejtidging its effectiveness. , 82 By the time AZ's exposure to the waterboard ended, he had been in detention almost five months. 80 . ' 41 'f'OF S;ElR&T/ ,r(b )( 1 ) .. 'NOPOPl_T __ :c:i_n_-r_~~(b )(3) NatSecAct·----~l_ro:::o_:c-_o:::o~ra" I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'f8P :!ECREl/I ltro·oP"OlttO'//M!t (b)(3) NatSecAct could handle that. (AZ also seemect'to be aware that he wasn't going to be allowed to injure himself on the waterboard, but was more emotional about the experience.) Ultimately it was 6Yl days of standing sleep deprivation (extending a day past the final use of the waterboard) that led KSM to lose his composure and begin to cooperate. · Thereafter, he too became a font of useful intelligence. The extensive waterboard use conceivably contributed to this, but it did not seem so to the _medical personnel. If . anything, the RMO thought KSM more steeled and recalcitrant just before and after the treatments, which also provided periodic relief from his standing sleep deprivation. an~egation An Agency Inspector General study of the detention program 'was ongoing at the time ofKSM's interrogation, and when is'f&ect in 2004 closely mirrored th~ OMS pe~s~ective. A~ency waterboard'use.,,~f~d the projected use of the technique as ongmally descnbed to DoJ." 83 Jn,a11 t~ee cases··.?JitJhe waterboard's use was accelerated after the limited application 0£.o~EITs ... becil~the waterboard was considered by some in Agency managemen~(dbe the 'silver bulle~~\m~ined with the belief that each of the three detainees pos~~s~~perishlble information ~i~ imminent threats against the United States." The"I~jh~t~AZ did pro~ide more intelligence after being subjected to the waterboard, But-s~id it was unclear whether another factor was at play. "In K h a l i ':uhamriuid•~ case, the waterboard was determined to be of limited effectiveness. @ne oould condu\le\t!il!! sleep deprivation was effective in this case, but a definitive colctusibn is,hard to r~h.considering the lengthy sleep deprivation followed extensive use~fth;~~tcib·oard." 8 ~·-·· g.tf§;~ms ''\L: ·~~ :~.t~ssed Several of the, . were, byJifuG in the months following the KSM interrogati~oJ, senibr White Hou.se officials, selected NSC principals, ~d the leadership of~ GQngressi~l Oversight Glenlinittees were all briefed on the Ag~bcy's. "exp~d~" -USeVli~ij@'&1.~~!}1~. .~~waterboard; and DoJ advised that from 85 their perspec~~Y~~~e dev1a~.Qt.l:~ were·'not ~tgmficant. I , ... , ..:· . ,._J!},mid-May.zCl~just ~~1~3··months after the waterboard was used on KSM, 86 the Ne~;Y~_rk Times_ carri~the ~rjt published refer~ce to Agency water~o~d use. The contex~~as.the pubhca~1.on JUSt a few weeks earlier of photos of Iraqi pnsoners being abused at}~~u Ghrai~. p~son. The Times article, based on information from sources with imperfect knowledge (who again alleged the withholding of pain ·v 83 Office of the Inspector 'General, "Counterterrorism Detention and Interrogation Activities (September 2001 - October 2003)," 7 May 2004, p. 5. 84 Office of the Inspector General, "Counterterrorism Detention and Interrogation Activities (September 2001-0ctober 2003)," 7 May 2004, p. 90-91. On~ of the SERE psychologists also had,explained that the "Agency's technique is different because it is 'for real' and is more poignant and convincing." (Office of the Inspector General, "Counterterrorism Detention and Interrogation Activities (September 2001 October 2003)," 7 May 2004, p. 357. 85 Office of the Inspector General, "Counterterrorism Detention and Interrogation Activities (September 2001 - October 2003)," 7 May 2004, p. 23-24. · 86 "Harsh CJ.A. Methods Cited in Top Qaeda I~terrogations," New York Times, 13 May 2004. '42 . 'feP sgsR:i:T I f(b )( 1 ) ~--~(b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 · (b)(~) Nat~ecAct 'fOP SECREl/j~-~l/NOl'ORN//MR (b)(3) NatSecAct medication), also correctly reported that Agency interrogation techniques were drawn from a military training program (unnamed), had been endorsed by the Justice Department, and used "graduated levels of force, including a technique known as 'water boarding."' Less accurately, waterboarding was said to involve a prisoner being "strapped down, forcibly pushed under water and made to believe he might drown." This article, and a Jun:e 2004 Washington Post article on DoJ's narrow 2002 definition oftorture, 87 ushered in an avalanche of press and editorial attention to interrogation techniques, which increasingly were labeled as "tortµre." The waterboard quickly became the symbol of Agency torture. Within the A&~(c·y~..t~ waterboard was recognized as being in a category by itself--being the sole E•J:f.qesignated"'Level 2"but, armed with the DoJ interpretation, both the Agency aqtl'WH~~ouse continued to den~ that Agency detainees had been tortured: Fac~ith~unre~enttp~ ~ritici~m, the White House and DoJ soon announced that the Augµst.2002 gu1dancell.~~s bemg redrafted. Pending this, the press reported, the Gitf°had put its harsh tacn't'~~ hold. 88 ~ne ~ ~ ~~-~ tereear~l_.since KSM)~;;·no In practice n: had been subjected to tHe new HVD taken into custody since the spring 2004 medi . prts. It wasn't so much that . "harsh" tactics were on hold, as that there were no new ~ates for enhanced (b)(1) interrogation. This changed at the end(e~ul~ when Janat ©u~ (b)(3) NatSecAct ~:W.as.transferr~,li"Agency custody. An alQa'ida facilitator, Gul was believed knowledg~aBie~e~out plqts timed to coincide with the ~ b,' .... ~,. ·. -· November 2004 Presider;itj_al.~lections; he i~ooiatel'y, W~ approved for a range of enhanced me~sures, ~oiigh·ria't.~e,waterboar~. Some senior man~gers still believe~ the waterboard might notfetheless 15,~ :1,1seful, so tlf~~.Agency asked Justice to re-evaluate its use in this specifi!cas~T. ".::· ;, .' :._· · .·: I I On A~,,2oj't,~{J{ti;,;tih~ considered it "a close and difficult question,:~·out conclu9~hat s~~i~g Gul to the waterboard "outside territory supject to Unif&i ..States jurisdi~tipn wouU:l ~ot~iolate any United States statute ... , nor would it viol,tefue United States Co~stitution or any treaty obligation of the United States." This judgment w.~~c?nditional ~physician and psychologist pre-evaluation and continued monitoring, an~n the basis of new RDG guidance-waterboard use being limited to . no more than two 2-hr waterboard sessions per day, with the total time of actual ~ "Memo Offered Justifl~ation for Use of Torture,'.' Washington Post, 8 June 2004. DoJ guidance had been alluded to, without specifics, as early as an 11 May 2004 Washington Post article, Secret World of U.S. Interrogations" and subseauentlv discussed in the New York Times. Newsweek and The Wall Street Journal. (b )( 1) 87 I (b)(3) NatSecAct aa "Document on Prison Tactics Disavowed," Associated Press, 23 June 2004; "Justice Dept. Rewrites Prison Advice," Associated Press, 24 June 2004; "CIA Puts Harsh Tactics on Hold," Washington Post, 27 June 2004. 43 'f8P. SEC~E!'f/ l~~~g~ NatSecAct----~r_MO_F_O_RM . l~------~I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct '%'OP SHeit!!T/I f /MeFe1\U))rm r (b)(3) NatSecAct (b)(3) CIAAct (b)(6) (b)(3) CIAAct (b)(6) (b)(3) CIAAct (b)(6) applications during the day not exceeding 20 minutes. there were to be no more than 15 days of use, dllring a maximized authorized period of30 days. ·on seeing the DoJ memo, OMS advised ROG that the new limits still posed potential medical risks. AccordinglyL).1S and[]lDG jointly revised the allowable exposures downward, further reducing the number of day_s during which the waterboard · could be used by two-thirds, and the time allowable for applications per 24-hours from 20 minutes to 12.89 DoJ was advised of these reductions, and incorporated them into a later approval. As previously, the primary OMS area of responsibilit~s safety and not value1or effectiveness. Neither OMS nor many in ROG beli~this reduced level · was operationally necessary. In extraordinarily resistant cas~~~~••l!,C~S believed that at most a single "warning" session of2-3 applications-pei:~s re~~ted once, at week Jater-might be tried if critical, urgent information w~i'irv~Ived, b~~ven then other /~'"-gation technique and environmental deprivation:~t that time"~~S advised that it did not have sufficient outcome data to make this ass~sment and U,:iat were the data provided there needed to be some written ~v-: ... . . . .. .. ,,~ ' •·' 89 No more than 6 applications often seconds or more were to be allowed in a session, and no more than 12 total minutes of application; no more than two sessions were allowed in a 24-hour period; and no more than five days ofwaterboard use in the 30-day period during which the waterboard was authorized. 90 No one in the SERE prograil was known to have experienced a laryngospasm, but this always was OMS' most serious concern. If needed, emergency intubation or a tracheostomy would have been very difficult in this case. 91 Office of the Inspector General, "Counterterrorism Detention and Interrogation Activities (September 2001- October 2003)," 7 May 2004, p. 8 44 \ TOP SECRET/ f(b )( 1) VNOFORN (b)(3) NatSecAct I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct . 'feP :'.5!!CR:ET I I I/M01"0ft:M//1'm (b)(3) NatSecAct assurance that a "study" of this sort would not violate Federal law against experimenting . on prisoners: 92 (b)(3) CIAAct (b)(6) When the Inspector General continued to press for a study, RDG proposed in early 2005 that an internal review be undertaken by a small team composed of a senior person from the Counter Intelligence Center, the recently retired[}vledical Services, and possibly a psychiatrist. At the time there had been only twenty-nine enhanced interrogation cases, so the analysis-now considered "quality control" rather than human subjects research-would be rather limited. Nonetheless, insigh~f~e considered likely to emerge. "EITs consistently associated with success likely~H e evident; those of questionable success also may be evident (e.g., in cases wh~r.e.··a~second EIT of more consistent success always has been concurrently presentk::,iA.t t~t, the record will allow a more data-based assessment of the original as§p,mP,tions ex·t{_~pplated from the military training programs, and allow some detefll\~(atfon_~ to wheffi-~ expectations regarding specific EITs in fact were realized."93 The unstated goal was tQ, oqjectively evaluate w~ether the waterboard had made any,p~s~:e con,tri~ution to the~,""tfam. individual:i~~tion . · In part to undermine the notion that techniques could be studied, psychologist/interrogators Jess~~ and Mitchellprc>vided an instructive overview of"interrogation and coercive physic~ressures."94 Refiisal to provide intelligence, they wrote, "is not overcome through the use of thi~'phy#cal tech;i1f/J(to obtain that , -.. J: . e.ffect .. .independent of the other forces atwork>~µeh.~tqi~~I}g'led some people not ~nv?l~ed i~ the actu~l p~~~.;.P:f interroga~~o believe~~t th~ relative contribll:ti~n of md1v1dual mterrogat10n techniques can be teased out and' quantified ...." [emphasis m original] Their W~f~)~ interrojors was said·. ~p ~~far more complicated: ~ch';h~""1techJ!iJ.-.. if any, to use is driven by an " ... the choice in4ivjtf~~ t~r~~errog:fibnipl~ and by a real-time assessment of 19f'a~tainee~s;·stte~8tl?"~e~.ses and r~actions t~ wh~t is happening. (b )( 1) (b)(3) CIAAct (b )(3) NatSecAct (b )(6) (b )( 1) (b)(3) CIAAct (b)(3) NatSecAct (b)(6) /'in this process;a.smgle pfi¥iP,al mterrogation techmque 1s almost never e·-,enr)loyed in isol~~ fromt--othertechniques and influence strategies, m~y\f which are ·n9t coercive. Rather, multiple techniques are delibe-r~)ly orchestrGted and sequenced as a means for inducing an unwilling.d~t~ine;z;fo actively seek a solution to his current predicament, and thus w~}{;~~ith the interrogator who has been responding in a firm, but fair and pred~(able way.',95 _ 92 . Memorandum for Deputy Director of Operations, "Review of CIA Detainee Program in Response to DCI Query," 30 June 2004. 93 "Study Proposal" attached to Lotus Note to 24 Febraury 2005. 94 James E. Mitchell, Ph.D. and John B. Jessen, Ph.D., "Interrogation and Coercive Physical Pressures: A Quick Overview," February 2005. This apparently is a derivative ofa paper prepared( at the time of the June 2004 DO review, "Using Coercive Pressure in Interrogation of High Value Targets." 9 s They continue: "As in all cases of exploitation, the interrogator seeks to induce an exploitable mental state and then take advantage of the opening to further manipulate the detainee. In many cases, coercive 45 'fOF s:se~~/ r(b)( 1) ~ (b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) · Nat~ecAct '!!QP SHCRE!'f/j r /UOFOR!l;'/HR (b)(3) NatSecAct Missing from this perspective was any question about just how many elements / were necessary for a successful "orchestration." The assumption was that a gifted interrogator would know best; and the implicit message was that this art fonn could not be objectively analyzed; Indeed, by this time their methodology was more nuanced, in stark contrast to the rap'id escalation and indiscriminate repetitions of early interrogations. Still, there remained a need to look more objectively for the least intrusive way to gain cooperation. origj.~ecommendation in Ultimately the Inspector General departed from the favor of an entirely "outside" review, by a ''blue ribbon" panef of individuals of some political prominence. In the wake of Abu Ghraib, and iq,.tli·e'c0ntext of intense media attention, suitable and willing candidates were not easUy obtained~v.entually John Hamre, Deputy Defense Secretary in the Clinton A~ini'stration, and Gatflner Peckham, an advisor to then House Speaker Newt Gingrich!(greed to undertake a·J}fimarily interview-based review. Without the requisite backgroundtfor the previou.sly.i~Itnned techni.cal analysis, their task became a relatively br~~~e~· of overall program effectiveness. - · ~- both'tdo~ In separate final reports, Peckli:...and Hamre the RDG program, but differed on the question of interrogation te~Jmigues. Peckham noted that the Inspector General's principal concern was!the w:mtroard, for.t~hich it thought there were equally viable alternatives; that RDd' did ·not consider the waterboard effective, and "contended that use of the wateftb.oard on lesser AQ [al-Qa'ida] operatives [than AZ and KSM] would not nece~sarily P7'1!luce more or better intelligence;" and that "OMS is candid in its discomforfwi~ this technique." He,then concluded: "It.~~;t~essi~at oth~~~Jet-wfu1d ~s effe~ti~e. be as the . waterboard, But that has· not been demonstrated. Until it 1s, I beheve that Jhe waterboard should continue-to be available in the EIT arsenal." 96 .···;;,:," "# f .., .. H~e.\Yas .less de~nitive. Noting that there was no objective yardstick by which to judge EIT ~'ectiveness,;.~ concluded that ''the data does suggest that EITs, when incorporated into a,g>mprehensive program based on sound underlying intelligence and analysis, did provi.de ·~eful intelligence products." However, ''there is no objective interrogation techniques are used initially to induce a sense of despair, but then discontinued when the detainee seeks to find a way out of his current predicament and becomes susceptible to other influence techniques. Interrogators then offer the detainee hope, and subsequently exploit this hope for intelligence purposes. In other words, physical techniques, if used, are most effective when employed to create an exploitable state of mind, rather than force rote compliance" 96 Gardner Peckham to DCI Porter Goss, "Assessment ofEITs Effectiveness," 2 September 2005. 46 'l?QP SECRET I {(b )( 1) rNOFORN (b)(3) NatSecAct I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) L Nat~ecAct 'f'OP SECRE I I j I _ /MOlfOJtM//Mil (b)(3) NatSecAct independent basis to assess whe~ EITs other than conditioning EITs [sleep deprivation, dietary manipulation] are required. 97 The August 2004 DoJ opinion on using the waterboard on Janat Gul coincided with a much more extensive review of the legality of nearly all interrogation techniques requested by the Agency in the wake of Abu Graib an4 ·associated Presidential . statements. As part of this review, Justice attorneys held extensive sessions with OMS, and requested and were;provided with written OMS critiques prepared for the May 2004 Inspector General report. This DoJ review (discussed below) spanhed almost a full year, and culminated in May 2005 memoranda that in essence reaffir.diidlfieir 2002 ruling (includi~g.the legality ~fthe waterboard). Unlike 2002, th~~~ra~dum relied heavily and exphc1tly on OMS mput, and underscored as never b.(fore ati~~pensable OMS role in legitimizing the program. . . '<~ ._ . . 20~~:~";;,i~n, anoth~~ecandidate (b )( 1 ) Within weeks of receipt of the May (b)(3) NatSecAct for the waterboard presented. This was Abu FaraJ ~l-L1b1I . lca:~red by the Pakistanis and transferred to the Agency in May 20.05. , lt)jJfflUy believed oqe of the most senior al-Qa'ida leaders, Faraj twice was subjected ~~ods of enhanced interrogation measures, with seemingly limited succes!). When the p~ssibility of waterboard use then . was raised, OMS advised RDG that it ·~Q~~~icipate onlylif.Jhere was real evidence that he had critical, time perishable infomj~fion.. ~is quickly""led to a rumor that Meqical (b)(3) CIAAct was withdrawing sup~rt from the progr~ w~Jt~~t\it~~hed senio~ Agency (b)(6) management. OMS (Sif!~e.~ober 2004, ~pwas req~~ted to explam the OMS position to the Agenc:y$s·~D~ect.or. of Support. (DS). DS asked whether it would be sufficient if OGC 81),tl~PO assured OMS that waterboard use was warranted; the answer· 98 was n~: OMS wofild'h~~~-J~ h~-Jt'~e evidence~~ectly. ~ definiti~e i~passe was never reached, however, becaus~:,~~~p.~or7-6;g~ncy1lJ1agement decided that m this case the waterboard .as U1U1ecessaf'y~ \··... ~ .. J ,). . . Raraj al-Libi prol5aely mar.kj!e final consideratio,n of waterboard use. With the pass.:l'a~ge-e·~ Detainee 1\~tmen~J~ct of2005, "Military Commissions Act" of2006, · and applicatien of Commo.icfo 3 of the Geneva Conventions, the Agency again asked POJ for. a ruling on tlie legality of several enhanced interrogation measures. The waterboard was neJ on ~ewly proposed list, and it is unlikely to be on any future request. The Mili~~ @emmissions Act (discussed below) made illegal any interrogation techniques that caus~ "serious" pain and suffering (vice "severe," previously). While the case may be ar~ble, the waterboard may not have survived that test. 99 \ 97 John Hamre to DCI Porter Goss, "Response to request from Director for Assessment ofEIT effectiveness," 25 September 2005 . · 98 OMS did not think the case· was there. Abu Faraj_ was believed once to have known the whereabouts of Osama bin Ladin and al-Zawahiri. Given his publicly announced capture many weeks before, any information he held no longer seemed perishable. 99 A different type of waterboard discussion may continue. The three HVDs subjected to the waterboard were interviewed by the ICRC after their transfer to Guantanamo. Their stori~s were highlighted in the 47 'f8F f(b)(1) SECR:B'l' /(b )(3) NatSecAct Approved for Release: 2018/08/13 C06541727 1 co6541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct TOP SE~RE'I'/ I ~u~u~/ /lVU< (b)(3) NatSecAct The waterboard, despite its role as a symbol of Agency torture, did not prove as psychologically overwhelming,as received SERE wisdom indicated, and it certainly was not irresistible-even in the face of a more aggressive, invasive, and potentially dangerous Agency methodology than used in SERE. It also was not intrinsically painful. There must have been physical discomfort from the occasional associated retching, but both AZ and KSM complained to the ICRC only of the pain of the restraining straps. Even the retching would have been eliminated had true SERE technique been_ employed. In short, the waterboard was primarily~ psychological measure. That said, had the true limits of SE\l£ use been known to OMS at the· outset, its application"wo~ld have been limited fo a few (ineffective) applications, leaving some to belieye that more applications would achieve the goal. Even very limited used may not,lJ:ave 'a\(~ided the devastating publi~ penalty ulti~ately paid by the Agency for i:~\ · .,~'.. As previously noted, an unrealistic expecmtion that waterboard appljcations would eventually "succeed" informed the Do/;'~dance, and underpinned it~xtensive use with AZ an4 KSM. Though not a medical question, p~fse;.OMS cameio.believe that the waterboard's impact as an interrogation tool wasjusN]le opposite. The waterboard experience was miserable but the effect.~ot necessarily~ulative (as was sleep deprivation). Once the shock of the initiat applications had passed KSM knew what was coming and developed coping strategies; ~ftef~AII!~Y applie~~?ns, he also had no reason to believe anything worse was likely to follow. In ~~~erice less coercive measures were likely to produce perish~ple informatipn at least a5~qpickly. To OMS this ·· · undermined the legal j\!Stific~tion for repetilit'e use.. dete~~~ wate;boardi~as intend~ DoJ also thJ\e legal because it was .not to threaten death (i.e., as iri a mock e~~~ion) .. :fithin OMS, this interpretation eventually was controyersial. ~T.h~ fact·that thousmiasiff SERE trainees had safely undergone the waterboafd would"lftf6e knoWlfto detainees, who in addition were in a hostile environm~nt vice training. Setting .aside interrogator intent, a lengthy initial application could ha-y~~ppeared to tfll:,~iiten de~ii. In theory, a detainee would have been desensitized b_efore this happened through applications lasting just a few seconds, which was Agency practice. EventUally, the detainee would realize that he could handle the longer application~~ddjp-.,;nally, most detainees quickly discerned-because of the ongoing medical attention-that there was no intent to seriously harm them. As a practical matter, all Uris is moot since by the time questions arose the waterboard was no longer in use. In the unlikely event that the waterboard is again considered a viable option, the question warrants further thought. ICRC report to the Agency, which DCIA Hayden then discussed wl.th Congressional Oversight Committees. At the time of this writing [June 2007] the Committees had ask for detailed analyses of the intelligence obtain~d before and after enhanced measures were employed, i.e., the question originally asked both by OMS and the Inspector General in 2003 and 2004. 48 \ J(b)(1) TOP SEeRE!'i'/(b)(3) NatSecAct VHSFOR:H I Approved for Release: 2018/08/13 C06541727 1 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct . '!OP SECREI/ ~-~ · /NOFORN//MR (b)(3) NatSecAct HVDs, JOO E/Ts, and OMS Guidelines When the OMS Guidelines in preparation at the time ofKSM's interrogation were completed, CTC/LGL requested they not be released: new DCI approval would be required, and he had just issued his own guidelines. OMS countered that its guidance was consistent with that of the DCI and provided a concise source of information needed by OMS field personnel. CTC/LGL relented, so long as "draft" was added to the title. The first week in April, 2003, the 9-page "Draft OMS Guidelines on Medical and Psychological Support to. Detainee Interrogations" first went to ~~~d. sh~J:ff • J This first issued. OMS Guidelines began with a qnen; of the SERE origins, DoJ sanction, and the psychological underpinnin~ oftn~P,rogram, then enumerated currently used interrogation techniques ("starl.tf?rd" a'ifu\.{lhanced"). Reference points and limits were provided for ambi~mperatures, Q.6~ levels, sleep deprivation, standing in shackles, and the use ~#confinement box. 'N~~rly a third of ·the text was devoted to the waterboard, begiry:iingt¥,i~h a ~scription which~licitly underscored the difference between Agency and s·~~usa~,.tu1 estimate.~as given of apparently safe levels of exposure--based on the hm1teot'xpenence to date--and a requirement levied for extensive medical documentati~~y future waterboard use. Medical contraindications also were li~e.·to this techn19~.e fot•mare than a few days, but our experience suggests otherWise." ~ ... · · ''···:;~ ......... .'' .ThelisM interrogations ·w were ;· onl~ the beginning ~fwhat proved to be the busiest ~ and most prodl(~tiye eighteen-months in the history of the RDG program. In a period (b )( 1 ) marked by the US.:Jed in~Ci'on oflraq (March 2003) and major terrorist bombings in (b)(3) NatSecAct Indonesia (Augus{2·9,q~)~ 101 I ~errorists came into Agency bands, includinQf sufficient importance';°fu warrant extended interrogation. The experience monitoring these interrogations proved instructive and other sources of information were also (b )( 1·) (b )(3) NatSecAct explored. Detailed Ft. Bragg SERE protocols were obtained, additional conversations · were held with both Anny and Navy SERE psychologists, and OMS physicians and psychologists observed courses at both Ft. Bragg and San Diego. In San Diego, DC/MS even underwent the waterboard. 100 101 Ove~ time High Value Targets (HVTs) came to be known as High Val~e Detainees (HVDs) E.g., the Jakarta Marriott, killing 10 and wounding 150. 49 TOP SHCRE'i'/ q~~g~ NatSecAct l/U9F9R:'N I I Approved for Release: 2018/08/13 C06541727 1 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) · Nat~ecAct 'fOP SECREr/I l/NviO!lN//Mr<: (b)(3) NatSecAct )- Ten new RDG detainees were interrogated between April and August 2003 with eight subjected to enhanced measures. The EIT mainstay, post-KSM,'was standing sleep deprivation (lasting from one to four days), punctuated by sessions which routinely , included attention slaps, walling and water dousing. 102 This-approach generally achieved cooperation within a week. A few detainees were confined briefly in large and Sfl?.all boxes but, as with AZ and Nashiri, this added little if anything to the process and after ,. September confinementboxes no longer were used. r · In a~dition to cooperation, standing sleep deprivation p4odu~ the first medical . complications seen in the RDG program. Several days of s~ing led to a slowly ascending edema of the lower legs, requiring that ankle sliiackles be loosened. In a few cases, the edema approached the level of the knee, in whfuh case m~jcal personnel required the detainee be seated, with the legs elev~ted, allowing alleviati<;>n of the edema while sleep deprivation continued. Occasionally;:"in addition to the edem~a detainee developed lower limb tenderness and erythell).~~ndings i~itially not easily / distinguishable from cellulitis or venous thrombosis. Thi~,.tYf>i~ally was as~eciated with pre-existing abrasions from shackling at the time of init~!-1· rendition. At first these cases were treated with antibiotics or antico,~gulants, but upon'•t\tv.g seated detainee recovery was so fast that a thrombotic or infectious phepomenon was'."ruled out, and medications ·:\. ·.:·. _.,. ': . ...,,.... could be discontinued. ;l' . There ~as an early concern that sJhding detainee~,;i.~~uld fall asleep and shift excessive weight onto !heir ~~,,but this did'~ot becomcf3.n issue even after s~veral days of standing. Ovenyh~elmingly the detainees simply continued to stand and periodically mo~~ around a littie:--·~!!e w~~dded alw~y~fartled themselves back awake. This . res1hence actually depnvea•them ·of an effecttxe counter-measure, because had they simply allowed them~elves to .'~llapse"4h~f weight onto their arms, the standing would have been disconti!hed.. 103 -~. · _ ··~ " .. . """''' ':~ tilts early years-·th<:mgh uiilrnown to OMS in 2003-the Agency regarded forced interro'gational stanclilig as dangerous. A widely-disseminated 1956 study asserted that the resutrffig.Jtema so~ led to circulatory and renal failure~ and psychosis. 104 ~- . Water dousing (often ~ng), though newly prominent among the interrogation techniques, had been addressed in the first issue"ff-OMS Guidelines. Most often water was simply splashed or hosed onto the detainee, but in the mos(extreme version the detainee was made to lie down on a plastic sheet, with water poured over him for I 0- I 5 minutes. A psychologist and PA had to be present, and the room temperature at least 70°. Consistent with SERE practice, doused detainees had to be dry before being placed in spaces with ambient temperatures less than 78°. See also Office of the Inspector General, "Counterterrorism Detention and Interrogation Activities (September 2001 - October 2003)/' 7 May 2004, p. 76 103 This suggestion is found in Agency commentary on detention as early as the 1950s. 104 "Many men c~ withstand the pain of long standing, but sooner or later all men succumb to the circulatory failure it produces. After 18 to 24 hours of continuous standing, there is an accumulation of fluid in the tissues of the legs. This dependent 'edema' is produced by fluid from the blood vessels. The ankles and feet of the prisoner swell to twice their normal circumference. The edema may rise up the legs 102 50 f(b)(1) !OP SEeKH'i'/(b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 1 co6541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct ':E'9F SEeitET / /MeFe!tM//MK (b)(3) NatSecAct Detainees in the RDG program provided no evidence for this belief. Their generally benign record probably is attributable to there being enough sJack in the shackling to allow a little movement and the periodic breaks occasioned by sessions using other interrogation measures. In all cases, once allowed to sit (and sleep), their recovery was rapid and complete. 5 '° Whether standing added anything to simple sleep deprivation was a point of some discussion. Simple sleep deprivation had not been effective during'AZ's first' · interrogation, and later detainees at least initially all began in ~-·{tandli1g position. The fatigue of st~ding presumably heightened the effect ofth~_i:;l~~p ~eprivation, but to what . "-.~""· degree remains unknown. <{t' (b)(3) CIAAct (b)(6) (b)(3) CIAAct (b)(6) (b)(3) CIAAct (b)(6) . OMS guidelines also increasingly address~j~i~·ie health'i~ t!1e post interrogation phase. As the number of post-int~~gation ~tainees gr~it~ no apparent prospect of transfer elsewhere, OM~~ad~tumed te the Federal ri"son system for (b)(6) ureau of insight into Jong-term prison care. In June 2003 die Prisons was invited to Headquarters to discuss problems Qf long-term confinement, and in mid-July0MS,C]MS, and[}1HD (accompanied b~'¥o senior ROG officers) · visited the Administrative Maximum ~X) "supermax" facility in Florence, Colorado, which then held the twenty-two terrorist~mpq~aaj in the F~M! system. The ADX staff provided a comprehensive tour and l>Fiefin~~t~gave a g~d feel for the ci~cumstances of detent~medical c~t~J'tl~i~ed;;,~~1their expe?ence wi~ terrorist 106 OMS Ie~ef 37 and 56 h~ witho'ttifsle,ep without complications, but this hallucination came aft~:o~y about 21 ,.urs. Since none of this sleep deprivation was at "enhanced" ~ . . (b )( 1) (b)(3) NatSecAct just under six yeafsl\~ In general Jhey were respectful toward the staff (though regularly tested the system),. but prior to transfer to~~orence two-thirds had been involved in prison violence, nine had threatened prison staff, and one was suspected of murder. About a third had made suicidal gestures; 12 had initiated hunger strikes (5 were fed invol~tanly by N-G tube). Extraordinarily modest, they for a long time refused recreation because of the prerequisite body search, and showered wearing underpants. With the exception of one elderly man, they were in good physical shape, and-remarkably-during psychological interviews or testing showed no diagnosable pathology. 107 "Draft OMS Guidelines on Medical and Psychological Support to Detainee Interrogations," September 4, 2003 [12 pp] 108 This fonnally corrected a significant deficit in medical documentation, initially had a no local records policy. In practice this had been corrected in January 2003 through cable reporting. 109 Issued 27 February 2004. . 110 The previous spring, a detainee claimed to have hallucinations, but careful psychological evaluation at the time proved this to be feigned. 52 r(b)(1) !OP SEC'itE!'/ (b)(3) NatSecAct l/nOFORU I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct !OP SECRET/I rJNOFORN//MR (b)(3) NatSecAct levels, there was no on-:site medical monitoring. When the hallucination was reported to. Headquarters, further sleep deprivation was barred. Later the "standard" limit ·was reduced. The change in the "enhanced" upper limit also reflected the program experience that it had been unnecessary to keep anyone awake even as long as 180 hours. (Only three of some 25 detainees eventually subjected to sleep deprivation even .were kept awake over 96 hours.) (b )( 1) (b)(3) CIAAct (b)(3) NatSecAct P~o'9!i_g medical. \J.,Cl p~ycholo~cal ~overage for b~th new. interrogations and the growmg number of widely d1spersed·detamees posed an mcreasm challen e (b )( 1)_ _ _ _ _ _ _ _---1 especially given tlie separa-re manpower demands in (b)(3) CIAAct (b)(3) NatSecAct 111 (b )( 1) (b)(3) NatSecAct At closurd ~etainees had been held there not all at the same time: (b )( 1) (b)(3) NatSecAct LOP SECRET I J(b)(1) (b )(3) NatSecAct I Approved for Release: 2018/08/13 C06541727 ) 1 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct !OP SECREI/ /NOFORN//MR (b)(3) NatSecAct late 2003 most physician coverage was handled by a headquarters-based physician newly assigned near-fulltime responsibility for program support. All psychological staff support was provided directly from Headquarters, as was most of the extern~iw~ rlemand to accompany rendition flights, including inter-facility movement. (b )( 1) (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct.-----L_--~------~~--------­ ~------ However, within weeks·tlle Supreme Court announced it woul(b)(1) consider a case which could have mandated court access to all Guantanamo-held (b)(3) NatSecAct detainees. 113 I I I... (b )( 1) (b)(3) NatSecAct ., The spridf2093 brl~fings to the White House, NSC and Hill on the Agency's expanded use of EITfJ!?"dto reassurances about the .legality of and continued support for the program, which still was generating over half the reportable intelligence on al-Qa'ida. However, the national cont~xt changed abruptly a year later when shocking photographs 113 Rasul v. Bush, o~ 29 June 2004, reversed a District Court decision, and held that the U.S. court system· 1 had the right to decide whether foreign nationals at Guantanamo were rightfully imprisoned. The case had been a ealed to the Su reme Court the revious Se tember, and the case heard on 20 April. (b )( 1) (b)(3) NatSecAct f(b)(1) !OP S!:Clt!T I (b )(3) NatSecAct I Approved for Release: 2018/08/13 C06541727 \_ C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) 'f6F Nat~ecAct ~EC:RE I I j I /:MOt"O!tM//l'm: (b)(3) NatSecAct of prisoner abuse at Abu Ghraib prison in Iraq were published in April 20Q4. 116 The international outrage that followed prompted White House and Pentagon condemnations of the abusive practices .and investigations of detainee treatment at both Abu Ghraib and Guantanamo Bay. The Agency, while not direct\y involved, again sought DoJ revalidation. The request to DoJ was more reflective of caution than a desire to limit the successful ROG program, especially in view of continuing high profile terrorist attacks. In March 2004 the Madrid bombings kilied 191 and in May the fiFs~.~f a series of nine gruesome beheadings took place in Iraq. Each of the latter case~liich extended until October, followed the same gruesome pattern: a terrorist ki9:~ning, followed by i~possible ~emands, videoed pleas fro~ the victim, and~cfu tR~f.~after a beheading, the Video ofwh1ch was released to the media. ~':.:. A'··. · Q (b )( 1) About June 2004 senior al-Qa'ida operati¥.e Janat Gui was captti~;J>y (b)(3) NatSecA~t IIater transferred to th~G program, promptin~;Ag¢ricy requests for a new rulmg on several EITs. In response to. sp~"i{ic questions~·,fioJ affirmed the legality of dietary manipulation, nudity, water dousing, abdominal slap-all not previous~y specifically addressed~.~ the waterbo~,In. ea~h instance, thes.e were . held not to violate U.S. law, the Constirub0n, or any treaty'obhgation. 117 As previously, ·use was explicitly preconditioned on m~·~ and psychological .~~aluation and the presence of on-site medical monitoring. It was the'se:·a1mrov.~1(that led to the OMS-ROG discussions that further limited the extent o~~ab~ ;?terboard use (previously discussed). Gul's intei:r'tfl~hri~like others'fpost-KSM-·'relied heavily on sleep deprivation, whic11.f<%!t1ie secdz:tg}(and final) tirrie in the program was associated with a hallucination. On.rthe'm$lih day ~!thout sleep, Gt.!~ began to hear voices. Medical personnel i~tervened, an'i!~~aj!~ep-sl~p, which end.ed the symptoms. 1 §.ffh~ end o. .04, ~~~~sued a hew. exp~ded versi~n.(27 pages~ 7-~age appen'di*') of its GuideI~~ Unexaoottdly, this particular version of the Gmdehnes bect'me~dation of t*Uiext issfrd DoJ opinions (in May 2005) on the legality of enhanced inteFI:ogation tecliiiiques: Among other changes, the December 2004 version reflected a su~_2004 5J.G decisi~n to ab~don the previous distin~tion b~t~een "standard" and "~~'tnterrogat1on techniques; there now was a smgle hstmg of approvable techniq~~~Additionally, the Guidelines followed ROG in listing some interrogation techniq°t'es separately as "conditions of confinement." These included such things as diapering/nudity, shaving, white noise, and continuous light or darkness. Exposure to "cool environments"-previously listed, but never used-was dropped (b)(1) (b)(3) NatSecAct 117 DoJ to John Rizzo, Acting General Counsel, 6 August 2004; DoJ to John Rizzo, Acting General Counsel, 26 August 2004. 55 ':FOP SJ!:CR-i:T/ f(b)(1) (b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'f01' SECREI/ j~__ l/NOFORFl//MR (b)(3) NatSecAct altogether. Other revisions incorporated the new limits on waterboard use, expanded the discussions of sleep deprivation and recovery, and specified immunization protocols. The new Guidelines.also reflected some ins.ights gained when OMS psychologists began attending conferences of the National Commission on Correctional Health Care (NCCHC) in the summer of 2004. These included a section on "restraint and sedation of violent detainees"-which fortunately never had any application within the RDG setting. Finally, new references wen~ provided, including the Federal Bureau of Prisons website (which had clinical practice guidelines), the NCCHC's regularly is~ued Standards for Health Service in Prisons, and Michael Puisis, Clinical Pract(c.e1i"W'~orrectional Medicine (1998). . .:'· : ~ 1 A n issue . ~.... a detamee.m . . ed.1ca1 of recumng concern was how to d eaIo.W•t (b )( 1) emergency. (b:(b)_(3) NatSecAct (b)(3) NatSecAct I ~--····" I•/ (b )( 1) (b)(3) NatSecAct 56 [(b)(1) SECREJ'l'/ (b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct Tors SELREl/I f /NUPORN//MR (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct ,,. .. r "·...·· ')I' 118 "OMS Guidelines on Medical and Psychological Support to Detainee Renditions, Interrogation, and Detention," September 2005 [29 pp+ 7 pp appendix] 57 [(b )( 1) -Tl"l"O'l'tifil-:31;1'1HOl.f:e:q;!R~Elcr/ (b)(3) NatSecAct/noFORH I I. ~I _ _ _ _ _ _ _ Approved for Release: 2018/08/13 C06541727 _I C06541727 Approved for Release: 2018/08/13 C06541727 . (b)(;:$) Nat~ecAct · /!'lvrv~/flYJ.K !OP SECREI/ (b)(3) NatSecAct Problems ofDetention (b)(1) By 2007 a total of97 detainees had been art of the ROG ro am. Prior to RDG (b)(3) NatSecAct_as_s_um_in~c_on_tr_o~lL___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~~~--_J About half the 97 RDG detainees came into Agency hands in 2003, and a fourth in 2004. In the final two years prior to the transfer of remaining detainees to Guantanamo Bay in September 2006, only 5-6 new detainees entered the program, with only two subjected to enhance~ measures. fo:· .. (b)(1) (b)(3) NatSecAct £·'/. .. When possible, ROG arranged to transfer detainees ne·fbnger ~f intelligence (b )( 1) value to the U.S. military, or render them to another coun@. ffespite new arrivals, this ~tend (b )(3) NatSecAct effort reduced the total number of detainees in Agency,cdrltrol fr~'m I of2003, to just in the spring of2004, andj.~.~t~at th~~ginning of2005. (b)(1) This figure remained relatively constant for theNxt y~an acceler~te4 effort (b)(3) NatSecAct during 2006 reduced the number remaining f<;>f...t(~~~er to ©uantanamo to ~gency ·1;/' Viewed differently, about 2/3 of detainees hands prior to October 2004 had been transferred out,,by circa the en~f~4; their detentions had ranged from a month to almost two yciar~~rol)ably averagin~uch more than a year. A large majority of the detainees not tr~eferr~d"oW of Agenc~·1fiands by the end of 2004 continued to be held for almost two mor~-~~ars;:::,Th~:~v-<:E~l~etention probably averaged about three years, and as true long:.,t.enn detaihe¢fthey presented a different set of medical challeng~~/:;-~-..7 ~ ~·, Jy -~ , . ~ OMS thou~~"~fli~ det~p.ee experien~~'~s"aivided into three phases: rendition and initial interrogation, s~staiped,cleb_ri;~fl~~...ah"d long-term detention. With the first two phases typ_ic~n~ting onl~.few weeK:s~fo;tfew months, by far the greatest.amount of a det·A.~me wa¥s11.ept sim~'in .detention. 120 With the sharp late-2004 decline in new am~a s, the medical r<1i.. . .s bee8?'1~-almost exclusively attendmg to long-term detamees' .v Agen~ainees 1 were, as··. group, basically young and healthy. Given bi- monthly or quarter·~iI!1edrfa'l check ups (more often if indicated), a healthful diet, vitamins, vaccines, aa~te rest, and some opportunity to exercise, most eventually were in better shape than ;i{en they came into Agency custody. Some were even willing to comment that they looked fitter than they had in years. (b )( 1) (b)(3) NatSecAct izo RDG characterized things similarly: an ·interrogation/exploitation phase lasted 1-10 weeks, with the most intense period rarely exceeding two weeks; a second, transition phase usually lasting two to three months during which the detainees cooperation was validated; and a third, debriefing phase which lasted from two to several months and in rare cases-such as AZ-for as long as three years. 58 1 r~· [ (b)(1) SEC!tET/ (b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'fSF :3EC::'.RET/ /NOP'OltM//Mit (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct A few detainees arrived with existing injuries, though none in as serious condition lhad sustained a GSW several months prior to as AZ. Ahmed Guleed I (b )( 1) capturer and arrived a~ ~ith a colostomy and frozen left elbow. Two detainees (b)(3) NatSecAct arrived_ lwith malleolar fractures sustained jumping from a high wall. Another detamee arrived with a broken finger. All required follow-up care and none were subjected to stressful interrogation either initially or later. The fracture group soon b)( ) ( 1 was transferred elsewhere, but Guleed's colostomy was successfully maintained for over (b)(3) NatSecAct two years before circumstances allowed a revision to be arranged. In the interim, he received professional guidance on physical theral'y to restore motion in his left elbow. Medically, of the nearly 100 detainees evaluated, none;Was HIV-positive, only · three ~ere he?atitis B and two ?epa~iti~ C antigen positi~~~e ~ved with a sexu~lly­ transm1tted d1sease--a chancro1d-mfhcted, he said, b.¥. a'genn (dJm. Most complamts while in detention were for relatively minor ailment(:Suth ls headaclies, mild musculo, skeletal symptoms, rashes, gastrointestinal upsets~6r an occasional pharyn "tis. :.t ,,, . Eventually a few dental problems arose, treat~"-bY''~ RDG).Q~mtract dentist~Jio from early 2004 periodically flew to detention sites to pf.~c.!e ,both ~rgutine and fi;lcused care. :rtal emergency arose, in 2006,I : I (b )( 1) (b )(3) NatSecAct Basi~ ~i~ion checks ere performed by.9~,~. personnel, and prison-safe g asses o tam . AZ m1tt~lly preferre . ear a p~tch over~, I_~:ft eye socket, b~t ~ventually requested an art1fic1al eye; tli\~ ... ·.:; t~tned, a nea(peifect match to hts good \•1', ""'~ ,,,;,.... .~. eye. \\ ...-r"-:.t.-.. ·:, ~ ~ :nlv asi:ele I : ~~ l~il NatSecAct ~~~g~ non~;~;n~ ~(w"~i~~uired beyo~d Over time, issues capabilities that available at the dete~tioµ sites'Cfi}1leed's colo~~~ need~ to be reve~s,._.ed~:G~ul~--nee<;t~·~ a bto.p~y for an enlar.mpg thyroid; al-Hasaw1I I· NatSecAct had hemorrho~~s and a &~~1.P,fl>iapse;·tlu:~e ..d~tainees required endoscopy for GERD symptoms; a.I.!a.Ji1Y'et:,b.~opsies, were indicated·for those with chronic hepatitis B or C. ;·~·· ... · .., ·~ . •; . :'qMS once hop :,,.~ D~~hlitment of Defense could provide this specialized care. (b )( 1) When se~Fal detainees ~ere trans~ed to j Puantanamo Bay in early 2004, a (b )(3) NatSecAct test case pres~filed. (b )( 1) (b)(1 )(b)(3) NatSecAct (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct As this concern was being addressed, the issue became moot. The ~p_e_n_d-in_g_S_u_p_r-em_e_C_o~urt decision that could have mandated access to all Guantanamo detainees led to the closure! (b )( 1) (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct I I 59 'feF s~sR:i:T I [(b )( 1) ~ (b)(3) NatSecAct . 1 - - - Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct TOI' SECREl/ j l/NOFORN//MR (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct OMS4.\~Y~~~ed While pursuing.the DOD option, RDG and over a dozen third-country alternatives. A combination of substandard•ll)edical:f!C:(te. and/or concerns about media exposure and internal politics had ruleaOalf'ofthose 'initially considered. (b )( 1) (b)(3) NatSecAct Attellilirfg,to the psxchological well-being of detainees was at least as challenging as dealing with~thefr-phy~i&fl needs. The impact of sustained isolation was the primary problem and provcllji\gr/psychologically challenging than had the interrogations. By design, no contact wjtli other detainees was allowed in Agency detention facilities and continuous white noise prevented them from hearing one another. Though physically (b )( 1) the· comparable to modem U.S. prisons detainee cells nonetheless were small and windowless. (b)(3) NatSecAct I I 121 I On the basis of blood tests, three of the detainees, including the subject with rectal prolapse once were considered cjtdidates for liver biopsy. Of these, one declined to be biopsied, one was transferred _before a biopsy could be arranged, and further testing of the third eliminated the need. (b )( 1) (b)(3) NatSecAct 60 'feF S'El91Ul'l'/ f(b)( 1 ) , r:NOFQ~ ~---Q_(b )(3) NatSecAct----_J-·------,I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct TOP SECREI/ J l/NOFORN//MR (b)(3) NatSecAct Initially, of course, detainees had weeks and sometimes months of frequent, often intense contact with Agency interrogators and debriefers. But as this phase ended, detainees eventually were left without the intellectual stimulation such contact afforded. Initial attempts to fill this void included "homework" (even when no intelligence requirement existed), the provision of books and other reading material, and mandatory staff contacts. At the extreme, KSM was invited to present staff lectures on various subjects. (b )( 1) (b)(3) NatSecAct :.c·~:: ·.;.... OMS concerns about the effects of~Jong-tefo1idetenti2n led to an acceleration of · RDG efforts to provide 1Y..9J~. ~~mulation t~~tain~~tThese concerns were shared by RDG personnel working dtr¢.c~ly with the-<;Jetainees, ahd by D/NCS, former Chief of CTC). This includ¢.~e prov1~~~P of video~bd games (eventually including hand-held computer games), ..an&.~. impl~m~ntation of "~cial" or "rapport-building" sessions, d~ng wh~ch s~~ffers _mi~~~~·:c~~~~f,.~?'gam~s with a detain~ or hold informal philosoph1ca_l.9~ss10ns. I~tlu,s sett1ng,:·many detainees came to view some of the staff, even prior interrogators·;·,as their·'.~friends." . . .. ',"... (b )( 1) (b)(3) NatSecAct Throughout the years of the RDG program OMS psychologists and psychiatrists made at least quarterly trips to each facility, and conducted extensive interviews with ·every detainee. Notably, in view of the terrorist behavior, at intake no detainee had a diagnosable mental disorder, not excepting such Axis II disorders as anti-social -~~~~~~-(-b)-(1-)~~~~~~~~~~~~~1· . (b)(3) NatSecAct I 61 '!'OJ.i SElCREl'i' / n~ ~g~ NatSecAct l/N9F9R,U I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) ':FeP Nat~ecAct ~Ec:r<:e: 1 / · /MOP'OltM'//r~ (b)(3) NatSecAct personality. 123 (This was consistent with the findings on terrorists held in the Federal prison system.) Some eventually developed adjustment problems, and at least two requested and were provided witfi'anti-depressants. Another asked for Prozac, which he had taken previously, and was sure it would make him feel better. It didn't, so the Prozac wa.s discontinued. Particular effort was made to identify signs of post-traumatic stress disorder (PTSD). Notably, even among those subjected to the most intense coercive measures, there were no indications of the emergence of PTSD. OMS practice regarqing the treatment of detainees who w.elce having difficulties with their situation was to work with RDG to ameliorate conditii.s ~s-much as possible within security bounds. Although at times CTC managers~~strated by OMS unwillingness to involuntarily medi~a~e ~et~ine~s who w~e "act~~~ut," medications (b )( 1) were offered only for bona fide medical mdicatton$ ll!ld with the pn~nseqt of the (b)(3) NatSecAct detainee. This mirrored the Federal Bureau of Prisons peli~y on involunt!lry medication. / . / / '·".~:; (b )( 1)-------, ' At least two detainees did appear to f~i.~~~ental illQ.esses. (b )(3) NatSecAct was concerned that guards would I_eam of~il~·~ I I He suddenl.r stopped speakmg and 1solat~ ._1_m_s_e~-o-m~-e-o~t-e-rs_i_n~1s~ (b )( 1) group ce~ll ]H?wever~ain~d vis~b~~-ned_to ~v~rything going on (b)(3) NatSecAct ~ound him, and was appr?pnately att9!~~1o ~Is activ1ties~.~,d~JY hvmg. When he was discretely reassured that his "secret" was'\i'safe w..ith us, he suddenly was able to express IV appreciation. On transfer to an entirely U.S. manaed facilitY,,.._ strikes ended soon after these feedings began. (b )( 1) One detamee, of some later notonety, ended a,hunger strilCe,~soon as an NG (b)(3) NatSecAct tube first was laid out and lubricated. Khaled al-Mafri~as·a G~erm__c:_:ail~·_:_.~c~:._·it'-iz_e_L__ _ _ _ transferred to the A enc., and rendered (b )( 1) (b)(3) NatSecAct ,c-----~~~~~~~~~- Subsequently al-Masri went public with ap. :accouo(embracedj)l the press and the (b)(1) ACLU, which variously alleged imprisonment[ ~iAjection with drugs (b)(3) NatSecAct(including rectally), furcOO,fe5!!ing, beatinili;d none of which was actually true. He had J!~ver·ev·en been interrqgat~, mucliless abused. An ACLUsupported al-Mas~¥~~it ag~t the AgencY,'~ventually was disallowed by the courts, and later he was arrestediin Getirany on a charge;ef arson-the result, his lawyer said, of 124 a "nervous ~re~down ~\utagre:to.the to~.r.lhe had endured in CIA custody". ..... :~.;~ ~. .. ¥ OMS'(;d Bure~~\! ofi>iiisbns) policy on forced feedings was directly counter to that.~~~ World Medic~l Assoctihn,ifthe American Medical Association, and most medical human rights groups. These groups held that the right to patient selfdeterminati~prevailed o-V~all other considerations. Within OMS, there was never any consideration given to allowing a detainee to starve himself to death, or otherwise kill himself. As wi~~~e F~deral prison system, RDG detention facilities were carefully designed to be as s'lf[~ide.;proof as possible. Suicidal behavior, should it have occurred, would have been se~lras a reflection of the psychiatric stresses associated with sexila~a15&., 124 The first of scores of article on the al-Masri case was "German's Claim of Kidnapping Brings Investigation of U.S. Link," New York Times, 9 January 2005. His arson arrest and involuntary admission to a psychiatric ward was-reported in, "German who claimed to be CIA torture victim detained on suspicion of arson," International Herald Tribune, 17 May 2007. A particularly trusting article, which also repeated the rectal suppository allegation, was Jane Mayer, "The Black Sites," The New Yorker, 13 August 2007. Mayer characterized al-Masri as "one of the more credible sources on the black-site program" 63 TOP SECRE'i'/ f~~~g~ NatSecAct I Approved for Release: 2018/08/13 C06541727 _J C06541727 I Approved for Release: 2018/08/13 C06541727 . (b)(;:$) 'feF sEellET / Nat~ecAct J l/Merieft:M//rHl (b)(3) NatSecAct incarceration and an uncertain future. Moreover, it was clear that had a detainee managed to kill himself any commendation for the Agency commitment to selfdetermination would have been lost in the demands for an immediate investigation. ~ ~- - :.... ·~:· ..... .. ~ ··~ -,;,··'·. ..Ii' 64 f(b)(1) TOP SEeRB'i' /(b )(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct TOP SECREI/ . /NOFURN//MR (b)(3) NatSecAct .J (b )( 1) (b)(3) NatSecAct 65 'feF SECRET/ I~~~g~ NatSecAct----~r_N_9F_9~RN I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'i'OF SE!CRE"f/ ~ l/NOFOffil//f1R (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct ·' (b )( 1) (b)(3) NatSecAct ABC News began a series of related reportsreports enumerated and briefly described six "enhanced interrogation techniques" said to be used by the Agency. Four techniques were correctly described: the attention gr~h. attention slap, the belly slap, and "long time standing." "Standing" for more than 40 hours, and associated sleep deprivation, was said which~a~s_o_w_o_n~t-e~1r;-,a~ut~or_s_a~u-1tz-er-. These 1 (b)(1) :(b)(3) 1NatSecAct 66 'i'QP Si:CRi:T I ~(b )( 1) ~--~(b)(3) NatSecAct ~NOFOPN ~------- Approved for Release: 2018/08/13 C06541727 I C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'f6P Sl!!CREI/ /MOl"OltM//Mtl (b)(3) NatSecAct to be "effective." A fifth identified technique was "the cold cell" in which a prisoner was said to be kept standing at a temperature near 50 degrees while being doused with cold water. This claim was only partially correct: standing arid dousing were done, but not in a cold room. The sixth identified technique was the previously reported "water boarding," though now described as binding the detainee to a board, wrapping cellophane around his face, and then pouring on water. · J This waterboard treatment was said to result in "almost instant pleas ~o bring the· treatment to a halt." Ibn Shaykh al Libbi was said to have been broken by it after two weeks of progressively harsher techniques had failed. CIA offi.cers subjected to the waterboard during trainings were said to last an average of 14 se~onds. AZ began cooperating after 31 seconds, while KSM had impressedA.nterrog~~ors by lasting between 2 and 2Yi minutes. '" . '~. ' All but one of the 12 high value targets l)~ld to datf were said to h~~ required waterboarding. The exception was Ramzi bin4J.::.srubh who r ortedl brolCe down after walkin ast the cell in which KSM was held. (b )( 1) (b)(3) NatSecAct Despite the Pulitzer, and the frequ~cy ~ith ~hich other media sources repeated , ABC claims, at best the~.:~~ reflected po~~ssw&fi{&sources with no direct knowledge of the program. ~li;:e never was~a "cold room" technique. Cellophane was never part of the w~telboard. 1 ".,Only three (rlet eleven) detainees had been on the waterboard. Shaykh 11f~ibbi never was on the waterboard. Neither AZ nor KSM "broke" on the waterboard. While AZ·once had water annlied for 30 seconds. KSM never had an appJi~n exceedjng 40 . s'e~fd;. I (b )( 1) (b)(3) NatSecAct 133 "CIA's Harsh Interrogation Techniques Described," ABCNews, 18 November 2005. Misreporting about the waterboard was common. For at least a year after first reporting of waterbaord use, the New York Times described it as involving literal submersion under water. The first to correctly characterize the technique was Newsweek . Eventually the Chicago Tribune carried the rather detailed description by a Navy SEAL who had experienced the technique himself, and who also reflected conventional SERE wisdom in saying it was "instantly effective on 100 percent of Navy SEALs." See "A Tortured Debate," Newsweek, 21 June 2004; "The Debate Over Torture," Newsweek, 21 November 2005; "Spilling Al Qaeda's Secrets," Chicago Tribune, 28 December 2005 134 ·. 'f'SF J(b)(1) SEl~E'r /(b )(3) NatSecAct Approved for Release: 2018/08/13 C06541727 67 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct TOP SECREI/ ~- /l'JOFORN//IOfR (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct 68 Teli sse~E'i'/q~~g~ NatSecAct Approved for Release: 2018/08/13 C06541727 1 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct TOP SECREl/I f /NUFURN//Io!R (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct , ,Khaled al-Masri-whose allegations of drugging, torture, ( b) ( 1 ) and forced feeding were all fabricated-1 (b)(3) NatSecAct I (b )( 1) (b)(3) NatSecAct '" I'·.;, ~eyond the ffsC:a.J:~~sts, these clo~ures \~ resulting moves took a--v~sible toll on the det'?n~es>For th':111; mov~eq~-~~;wtressful because o~the associated . uncertambe$,. Attending medteal persersonnel comomed the societal obligation with a responsibility for patient well-be'i~g. 1 The medical ~ence reflected . >11 b . 41-,.cth d . ~1~-~ a government commitment tothe fu ndament~I/, ~w~~emg O.i,-,: e etamee, wtf~ e·not allowing this commitment to preclude the acquisiti'Ciitof iii/poit!lflt, time-pefiihable intelligence not otherwise obtainable. The limits mid~(personnel set, and interventions made, allowed for the acquisition of ~greatest possible _ln(ormation without placing the . detainee at medical risk. In combinat~ghtly;~scribed policies on coercive measures, medical monitoring'Rare'G filmost all det:ifrets" from experiencing more than a very time-limited period of cf\~omJor.t.:...-,,,:.:'. ·>.··:-:-?I" . • ...... .,_ .t.. \\.I.,,. .V "'t.t'/ JtP. I In the continued ethica.l.r~iterations o,2005, some tacit acknowledgement of the societal obligationpc~asional!Y:.~as implied, ll~t only to be immediately discounted because some empirl~~~evide~ce" eliminatedby4 potential ethical conflict. Both ethicists and the press ;egu!~rly.M.§'trted~~t .B9~cive measures were ineffective if not ~d proaifea seriitis Miafong-lasting physical and psychological .counterpr9g:uerlVe, . .,,...• ,..~ ~i:'\\ aftereffecits. More..jfa~ntedly, ·th~ presence of medical personnel during interrogations was sy:S'to embolden the i~terrogat<>FS~d lessen their restraints, thus placing inte~ogat~t ~eat~r, ndt~s~r ri~ ~t worst, any physfoian present risked being coopted, or so·ciahzed mto a Nazi mentahty. 145 ~ I . Howevef-fuu~h such;"facts" simplified the ethicist:s case, the OMS empirical experience was jusf~posite. Invaluable intelligence resulted, medical and psychological aftereffects were not evident, &nd the presence of medical personnel unquestionably moderated interrogations and led to more benign interrogation guidelines. Medical autonomy also was preserved, with OMS personnel answering professionally only to OMS. Medical personnel were allowed to provide,care to detainees even under 144 Analogous dual physician roles are seen in forensic psychiatry, and occupational and public health, in which the public good sometimes overrides patient preferences. 145 Rubenstein et al, "Coercive U.S. Interrogation Policies." 71 'feP S:SeRB'I'/ [~~~g~ NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) 'f81!1 S!!CRE I Nat~ecAct Ij I /MOFOltM//M!l (b)(3) NatSecAct interrogation, in a professional and humane manner; and no one ever was asked to use medical expertise against a detainee, or to withhold treatment. Finally, the carefully managed, selectively targeted Agency approach to interrogation had almost nothing in common with the excesses, program laxity, and indiscriminate focus alleged at Abu Ghraib and Guantanamo. From the outset, the RDG program was tightly circumscribed and carefully monitored, and quickly corrected problems encountered in the fo~ative months. Almost from the outset, all interrogators, debriefers, guards, and medical personnel were prescreened, traineQ, guided both oralJy and in writing, and then monitored throughout their involvemeR.~detainees. Despite its press image, this was a very carefully controlled pro?~ · Program details-beyond that asserted in the ~.¢i~;-were"pf course, unknown to medical ethicists, but even with a more accurate ulidei-stahding they~ely would have reached the same conclusions. This was not necessarily the OMS expectation when the first medical ethics articles appeared in 2004. :· Un~~are ju~~ow disprop~o.nafe had . become the ethicists' commitments ~o the patient~iia-vj,~~ciety, there w~·~ome passing frustration at the mindset that casually equatl~ld to modest measures (e.g., limited sleep deprivation, or feeding through an NG tubefwith sadistic, potentially lethal 146 physical ·violen~e. All were torture or ~aqtamount to it. Mu~h_ !)}Ore useful would have been thoughtful, medically informed re~µufi'mtdations to h~1)afance the acceptable degrees of coercion against the immediacy. and .~av~D'.•.gf-an avoidable terrorist threat. . Ethicist view~~ho~ in "in~":tional" -~humanitiman" legal standards and profe~~'0nal declarations datmg~tp the mid-1970s. Until the Administration's i'002;o~;ton that al-Q'\:i.da terrorists were not legal combatants and thus .not ~-r~!~~ted by ~~ne:v.a~~-~~~;~Common ~cle 3_ ~f the Geneva . Conventi~i;i~_prQ.~l~~~ sohB~t~gal conieFSt~me for the ethicist position. Common Article 3 prohib.iteo "at any-tjme and ilf~Jl~._Place whatsoever: violence to life and person, in parti~~ar. murder of aIJ-.tdrtds, mutilatien, cruel treatment and torture; outrages upon per~nat~l~ity, in parti~~1;~ humilffting and degrading treatment." A prohibition against criiel,""' humiliating qr.degrading treatment, or outrages on personal dignity could ..., •· I be and were us~~to cover !a-.very wide range of interrogation measures. ~( . ~ '.:,,, ·''~· 1e 3, there sti'II wasth e UN Convention . A gamst . T orture, Ab sent C ommen'ruLic which as ratified by U.S. barred the "intentional infliction of severe physical or mental pain and suffering." This was a much higher threshold, more genuinely consistent with what popularly would have been deemed torture. However, this too had been . further circumscribed by DoJ's determination that "severe" pain was akin to that accompanying serious -physical injury or organ failure, and that severe mental harm must last "months or years." _ffif 146 Medical ethicists and the critical press were not the only ones to take this view. Even some who advocated the use of what the Agency viewed as coercive interrogation referred to it as justifiable "torture." 72 TOP SECRE'%'/ l~~~g~ NatSecAct----~r_NO_F_O~R:N I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'f9P SE!€~H'f/I f /HOFOR11//HR (b)(3) NatSecAct Further, along with railing at the Administration's permissive interpretations and asserting a humanitarian obligation to follow the Geneva Accords even if they were not legally binding, ethicists turned to another potentially valuable ally to carry their case-, the professional associations of organized medicine. ' l)le acknowledged foundational guidance on physicians and interrogation was issued in 1975 by the World Medical Association (WMA) 147 in response to questions about physician responsibiliti.es in coercive interrogations of Northern Ireland militants. The WMA's "~e~larat~on ofTok~o" held that ~hysicians sho~d not '~cou~tenan~e, condone or part1c1pate m the practice of torture 48 or other fe'fms of cruel, mhuman or degra~~ng procedure~," nor "provide any premises, ins~ents, ~\-tances o~ knowledge / to facilitate the practice of torture or other forms of C!)lel~ ~uman ©{~degrading treatment or to diminish the ability of the victim t<3:'}~~:.such treatmen~. .Doctors were not to be present "during any procedure during wliich torture or other fo~s,of cruel, inhuman or degrading treatment are used or thteate.Qed." In ~hort, "the .doctoi::st fundamental role is to alleviate the distress of his or her fellow•men, and no motive whether personal, collective or political shall prevail against this higher purpose." The WMA reissued this declaration in both 2005 and 200~fter the extensive press reports of2004-2005-adding a new section ~tlhg that physician~pould not ''use nor allow to be used, as far as he or she can, medical knowledge or skills, or health information specific to individuals, to facilitate or otherwise..:!ld:·~t\fj(~!Jogation, legal or illegal, of those individuals" (em~2-~~ed). ~.,..I 4Y ~~rican i~~ciation "P~ychological In 2005 the. .Psychological also addressed Ethics and Nationru S:ecurity," partially in response to accusations of unethical behavior by Behavioral Science Cons~.J!afi-~~~--.0~.~CT, or "biscuits") at Guantanamo Bay. These teams w~e"comprisea . .Qf a psychiatrist, a psychologist, and a medical assistant, who sought to bring,~Ci~Q.sights of behavioral science to the interrogation process: Alleg.!hey had. use1:lt'medical r~~9rds to devise interrogation strategies. The AP A (psychologi!!t), without addressing)my specific allegation, enumerated the "ethical obligation~ltnational sec®y-related work." More nuanced than guidance s~on issued by medical orga.iµ.zations, tffi-s advised that psychologists: '1·v ·~ . --should not engage in, direct, support, facilitate, or offer training in torture or other}""ru'el, inhuman, or degrading treatment; · --do not use health care related information from an individual's medical record ''to the detriment of the individual's safety and well-being"; --do not engage in behavior that violates U.S. law and may refuse for ethical 147 The WMA was established immediately after World War II to address issues of international concern. The American Medical Association was one of many founders. 148 Torture was defined by the WMA as "the deliberate, systematic or wanton infliction of physical or mental suffering ... to force another person to yield1information, to· make a confession, or for any other reason." 73 ':FOP Si:'1RiT I l(b )( 1 ) . (b)(3) NatSecAct l/NOFOPN I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 Nat~ecAct (b)(;:$) I l/Nvl'ORN//tvni 'fOP SECREI/ j (b)(3) NatSecAct rea5ons to follow laws that are unjust or that violate basic principles of human rights [but if a conflict results, they "may adhere to the requirements of the law"] --"are sensitive to the problems inherent in mixing potentially inconsistent roles such as health care provider and consultant to an interrogation, and refrain from engaging in such multiple relationships" --"may serve in various national security-related roles, such as a consult~t to an interrogation, in a manner that is consistent with the Ethics Code, and when so doing ... are mindful. .. of contexts that reqU,~r~ special ethical consideration." Ay··--·' The: following year an. August 2006 AP A resolution aligreq Ji~~'\it position more specifically with the United Nations Convention Against'T~rture, ~<;H,Pe McCain Amendment (see following sections), but added n~~liffional specifiCi~the guidance. /~ A;sociati01:i{tli~ugh i~·~;' The American Psychiatric cortcemed over the Guantanamo reports, did not issue its own guidan"c.e for an6th'er)year. In Mll-Y 2006, this AP A (psychiatrist) issued a "Position Statement" on~~yl'hiatric Participation in Interrogation of Detainees," which stated that psychiatristi'sQ.ould not participate in; or otherwise assist or facilitate, the comrift~ion of torture." It-cdntinued, in part: .. . , ~ shou~articiDate ·'¥·~7 i6.'~he · " ... No psychiatrist HiFectl>.: interrogation of persons held in cu:>t9dy by milit~ of~ivilian~~hvestigative or law United sfrtes or elsewhere. Direct enforcement auth~fi~~hether in participati~nf.udes ~ing present iritthe interrogation room, asking or sugg~sting qu~s~, o~lvi~ing au~o~ties o~ the use of specific techm~~ ~f mter.ra,~n'-W:UJ.lt~art1c~l~ detam~e~.. Ho.weve~, . psyc.]ilaj~~ts·m~y preMtde tramm~~1htary or c1v1han mvestlgative or law· enforcemen!lP.ers~~n recognizing and responding to. persoris with ~~ntal illness~~oftJhe possjble•medical and psychological effects of · lfaiticular techniqtie~land cawditions of interrogation, and 'on other areas witlll~'their profes~iahal e:J,ertise." · •• ., J,"'"'1 mf '·'-'.:.~ ~" ll'I",' ~. . Until mfd;?oo7 9MS psychologists, iiven the legality of Agency practices (r_eaffirmed by DoJ'i~~arch 2005), saw themselves as working within the AP A (psychologist) guideliries. OMS psychiatrists never were .asked to monitor interrogations, though not as a matter of policy. Initially, psychologists were more available and soon they were more experienced. The AP A (psychiatrist) guidelines were the more restrictive pf the two, but on careful reading might still have allowed a role similar to that actually performed by OMS psychologists. The next issued, and more categorical guidance came from the American· Medical Association: "Physicians must not conduct, directly participate in, or monitor an interrogation with· an intent to intervene, because this undermines the physician's role as I 74 TOJ.9 :3E€RE'i'/ [~~~g~ NatSecAct I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'fell S:ECREI/I f /MO!l'O!tM//M!t (b)(3) NatSecAct healer." In a modest concession to the physician's societal obligations, the statement added, "Because it is justifiable for physicians to serve in roles that serve the public interest, the AMA policy permits physicians to develop general interrogation strategies that are not coercive, but are humane and respect the right of individuals." 149 Since medical licensure in the United States is the exclusive purview of state medical boards, professional organizations such as the AMA have no direct power to enforce their views. State boards act on ethics violations, however, so the policy do have a potential impact-:-... Critics very early statements of professional organizations . . sought to bring about change ~t Guantanamo Bay by attacking~the Iicensure of the supporting medical staffs. Soon after the role ofBSCT tem:!J.};~~as publicized, the New York Times reported that lawyers representing detainees .~fie ~g..to gather doctor's names to bring ethics changes against them in their home~~~~tes. 15 \E~i.ling in this effort, lawyers later targeted physician John Edmondson~ander of the"eyuantanamo Bay Naval Hospital. In July 2005, a complaint against1Edmondson was file~it4 the d his TI'eense. He wa8-:-eli&:{ed with California State Board of Medicine, which h~d ''unprofessional" conduct, including having overseeg: . e ila15Ptopriate shari~ of medical data, refusal of treatment, and active and passive invol:yt?~ent in physical abuse. The Board declined to pursue the case on~the grounds that if'~ld take no action against a milit~ physician practicing on a milh~:h.~&~,absent ac~§~y the. military. They als.o cited a recently ~eleased study by AW1y-S~rfi~3tJ:.General~~Hey; which had not found evidence of any medical abuse of the detaw~es;~/ ·::~~~Z,,"t"".',? ~' ~"4· ·.:.. .rif" ~';.c;;; -"'i.~grg',j} 'W" A few weeks later=o~ :the fourth anniversary of;9/11-131 Guantanamo Bay detainees began a hm('er strik~:. tO: protest the\onditions of their detention and lack of due process. Ofthese~re involuntarily fed ti1ougb naso-gastric tubes, most compliantly and -~ithin "th¢.~r. feits¥1' 52Jhe first substantial discussion of this issue, however, did not come until after ~·een remaining HVDs were transferred to Guantanamo Bay in September 2006. .'fhe I@R, ~ . '•I,••, --~ ' '•, ~''•'····" ~ '"\~-) ....,.... .. ' '\.':•;.~.. , wH In i 991, th~~ position modified to allow the optio~ of physician intervention once the patient became confused or 111-~sed into co~a. but both the Bureau of Prisons and the physicians at Guantanamo Bay act far before thlst~ge is~ched. In 2006 the WMA issued a lengthy further revision of its policy statement, which concl'irci~orcible feeding is never ethically acceptable. Even if intended to benefit, feeding accompanied by,,.llifuats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment." Moreover, "(i]f a physician is unable for reasons of conscience to abide by a hunger striker's refusal of treatment or artificial feeding, .... [he or she] should refer the hunger striker to another physician who is willing to abide by the ... refusal." World Medical Association Declaration on Hunger Strikers, as revised by the WMA General Assembly, Pilanesberg, South Africa, October 2006. 154 Jurist, 8 January 2008; for fuller coverage, The Observer, 8 January 2006, on Guardian Unlimited, accessed at http://observer.guardian.co.uk/world/story/0, 16937 ,1681736,00.html,. Subsequently, a British activist physician again filed this same charge against Edmondson with the medical boards of the states of California and Georgia. See "Force feeding at Guantanamo breaches ethics, doctors say," BMJ 332:569 (I I March 2006).· m "ICRC Report on the Tre~tment offourteen 'High Value Detainees' in CIA Custody," February 2007. 153 76 'fOP SESRi:T I I(b )( 1 ) (b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'f6P SECREr/I f /NOFORN//IOIR (b)(3) NatSecAct Labeling Agency interrogations ill-treatment tantamount to torture, the ICRC judged that the Agency program did not qualify as a "lawful interrogation, [in which] a physician may be asked to provide a medical opinion, within the usual bounds of medical confidentiality, as to whether existing mental or physical health problems would preclude an individual from being questioned," oy "requested to provide medical treatment to a person suffering C;l medical emergency during questioning." Rather, medical personnel were "ruling on the pennissibility... of physical or psychological ill-treatment." Their conclusion, therefore, was that: .. .... the mterrogation · · process is · contrary to !n1!iPationa · A11 aw ·and the participation of health personnel in such a process ~co~trary to international standards of medical ethics. In the case of~~leged . participation of health personnel in the detenti.on "I,~ inte~gation of the fourteen detainees, their primary purpose appears·.to have be~serve the interrogation process, and not the patient.. .Is so doing the health: P.~onnel have condoned, and participated in ill-treatment."·?.. · ·-,~~ :.':~. , ~:·~"'- Like many human rights and professional ~~if1f6rganizations, the ICRC held the traditional formulaic view that th~~· were three corrtioiling principles in medical ethics: act always in the best interest of the patient, do no har.qi.~o.the patient, and insure the patient's right to dignity.. Had OMS,~sessci:Ht$elf ag'!lin~these criteria, it would have said that during the entfre post-intertogatio!fpiUrse of d.etention these principles were honored .. Excepti~p~l.Y- a handful of ~nvolootary ~edings, co~sent was obtained before all medical pro~dure~r they were not undertal(en. 15 Dunng the Agency's legally-sanction i~6ations,wever, the pi:eservation of detainee dignity and "best interest" woufd have Cl~ed t~~;J?rocess, at t~ost of innocent lives. Given the ma~itude of!.11~--£~ceiv~t~~~FiStilf£t~;mvrt periods ofindignit~ and significant but medically ,sl!f~tQ_!Scbmfort (far:&ftrt of sei:ie.us, much less severe pam) seemed an ethical~~frieonseqiren..t!~Lprice·to p,ay to obtain the cooperation necessary to save lives. OM§:..#on~theless still ~?~ble ~iYisure that no harm befell detainees while fulfilling a soci=etal'o.!Jligation that ot~efytise ~'Jilild have been impossible. There never was any . question tha~~f.g_rced to mal\~ja choice, the preservation oflives would override the preservation of dignity. 1. i f ',,.....~, ' ·-~ u !.V . w~.;"'~ \' ,,..-}" l,.. ,,J. 156 Tube feeding, while involuntary, was never forced, as the detainees always cooperated with the procedure. An intake physical examination, including appropriate blood work, also was mandatory, but after the interrogation phase detainees could decline physical exams (or elements of the exam) or laboratory studies, though almost none did. Concurrence was obtained in writing for all invasive procedures. There . sometimes was a certain incongruity in asking a detainee for consent. At one point Nashiri, who at the time was manacled and closely attended by guards (because of recent acting out), laughed when the attending . dentist asked his perinission to pull a problem tooth: "You obviously can do anything you want," Nashiri noted. But he did give his consent. / 77 , r(b)(1) 'feF SECRH'f/ '1(b)(3) NatSecAct hmrmm I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'fOP 5ECREt/] f/NvFORN//rotR (b)(3) NatSecAct Notabl.f, the ICRC's report on the fourteen detainees was not immediately leaked to the press. 15 The record to date suggests that this eventually will happen, at which time advocacy groups probably will attempt to attack the licensure of some OMS physicians. There are several reasons to believe that most if not all state medical boards would deal with ethics charges much as had California: --DoJ had provided legal sanction to the program --the CJ.A. (like DoD) would strongly assert the legal, ethical, and appropriately circumscribed role of the medical staff ..¢.· , --sp~cific individual medical responsibilities likely woµ~~ain classified --Bureau of Prisons policy and medical personnel w,.olila-be similarly implicated --even were existing medical ethical guidance rele~lnt;fr~IJ:S sufficic;mtly imprecise that it had to be clarified in 2006,\after whi~h no enhanced "\~.l.., interrogations took place. 158 -- - - ~ ~ ~~legal ~d A greater problem than licensure per se may professional'hai:Vsment of activists hoping to end an unpopular program byd~ngl}Y~.1:i_ts medical sJPJ,ort, in essence exploiting the government's commitment to in..,..s.~png that detainees are not ~ hannOO. }:;~~~·gical ~ In August 2007, the Associatieb ·revisited their 2005 and . American ' ··. ., 2006 statements on psychologist support fo, interr>i;>gaiio11~, and:.-issued much more explicit and categorical guidance~i~.. included ah 1 t·~9ib1u~ihltion for psychologists against direct or indir~¢~i¢ipation·in int~ogations or in any other detainee-related operations" involv.~~~ :Jength)i&t of technitj~~s alleged in media reports. Most relevant were hooding, forced'hakednes~tress positiori~z;slapping or shaking, and "sensory deprivation and over-stiimtl'atioi:i::iw:.~orsle.~P...<:le°'privation used in a manner that ~epresen~_Nw~c~~-.~ain o~~~µffering'or.;;irtft'manner that a re~onable person would )Udge t'i>•cause lastr~~m:m·" :S~~~~ovement to bar psychologists altogether from interrogation facilities\v_as_ 11ot stib:c.e,ssful. By the time this was issued (see following section~be only clearl§+~~vant)t~m w~ slapping, though standing sleep deprivation · would prob~~have been ~ntroversial. ~;,- p~obJ~atic. tan More barring psychologist involvement'in the prohibited techniques was a req~e'.ffient that AP A members report any psychologist who has ; . In spring 2007, DCIA Hayden was asked to address Congressional Oversight Committees on various charges contained in the ICRC report. In these Hayden categorically denied any medical role other than ·monitoring the well-being of the detainees and providing treatment when indicated. . us AP A (psychologist) guidance was less restrictive, but even so only one such interrogation took place after it released new guidance in 2005. 9 is "Reaffinnation of the American Psychological Association Position Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment and Its Application to Individuals Defined in the United States Code as 'Enemy Combatants,"' Resolution Adopted by APA on August 19, 2007. Among the dozen or more enumerated techniques were waterboarding, hypothennia, exposure to extreme heat or cold, and exploitation of phobias or other psychopathology. 1S 7 78 'f'OF SB~l!:T/ f(b)( 1 ) ~--~(b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727 'C06541 727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) 'f'e~ :!ECRE I Nat~ecAct I r I /MO~OMiJ//Itftt (b)(3) NatSecAct participates in these techniques to the AP A ,Ethics Committee, who in tum could revoke memberships and potentially jeopardize state licensure. 160 This; in essence, placed Agency psychologists in the same potentially vulnerable position as Agency physicians. 160 "AP A Rules on Interrogation Abuse," Washington Post, 20 August 2007; Eve Conant, :'Capital Sources: Shrinks and Torture," Newsweek"Web Exclusive," 20 August 2007. 79 TOP -SECRET I f(b )( 1) ~--~(b)(3) NatSecAct VNOFOBN I j Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) 'fell Nat~ecAct ~'.ECRE1/I f /MOP"OM\1//ru:rR (b)(3) NatSecAct An Unfinished Chapter The new DoJ policy statement on torture issued in December 2004 stated that it did not invalidate previous guidance on specific interrogation techniques. DoJ's longawaited re-evaluation of these techniques finally was forwarded to the Agency in May 2005. Three separate memoranda were sent, all reflecting an understanding of Agency practice and experience not available in 2002-as well as insights gleaned from the voluntary waterboarding of a senior DoJ lawyer. a~Cted · A foundational· 10 May 2005. memoranda corrected the 2002 descriptions, then reaffirmed that the previously addres.sed toomrigues fell short of 161 torture. These were three conditioning techniques (dietfF'Y ~ahlpulation, nudity at. . . ambient temperature of at least 68°, and sleep deprivatio~~five corr~~tive techniques ' (attention grasp, facial hold, facial or insult slap, apd~hal"sl.ap, an~alling), and four coercive 'techniques (stress positions, water dou.srnf, cramped confinem'c~nt,,.f!lld waterboard). A second 10 May 2005 memorand~:.express!y extended this~clusion to the combined use of these techniques. 162 The final.µie]J1orlfn'nupl, dated 30,Nfay 2005, responded to an Agency IG concern in affirming that~ilie~ techniques were not barred by Aqi~le 16 of the C.onvention A~ainst~~· ~s ratifieo i~ b~rred "cruel, unusual, and mhumane treatment or pumshmen~1p~~h1b.!_ted by the..., l·W~glith, and Fourteenth A'.mendments to the Constitution." As int~tprt(teo· !Qe Fifth A?oment was of greatest relevance, and the Supreme Court standara agaii\~t . .wlii~h-~atment was to be measured was whether a techique.:~J~:~Q.egre~ous, sb~~~frageo~-f~afit may fai~ly be·said to shock the c.ontemporary cons~enc.Judgment·~~ted by the·Court to be h1glily context163 . z:. 1,\.·\ . spec1fic and fact-deplfident. ..,;, "\. ., .. er '"' '-,;·.;.!~ ~.,.. \ ~ .. / ') New to the 200S:~idan. Mias an.ex~r~ordinary reliance on OMS input, totally absent in ~~07.~,~.gency~si'eneral'Co ~el, during an early 2004 visit, had mentioned that OMS. involvemeritlnow was central to the Agency's legal case. Just how important becam~.clearer in summer OMS-DoJ discussions during which C/MS finally observed "• """"'' . ·' that ""DoJ~~~ed-to be und§the n~Jsimpression that this was an OMS program-rather than OMS supporting CTG~G. In acknowledging an overemphasis, DoJ nonetheless ·said the presenc~·of OMS was critical to their determinations. OMS thereafter tried to y .• . remain alert to tqmsfo:hhation from the notion that the ROG program being acceptable in part b~~1fof OMS involvement into something that sounded more like any ~.. ;r/ . . . 161 Steven Bradbury (DoJ/OLC) to John A Rizzo, Senior Deputy General Counsel, Central Intelligence Agency "Re: Application of 18 U.S.C. 2340-2340A to Certain Techniques That May Be Used in the Interrogation of a High Value al Qaeda Detainee," l 0 May 2005. 162 "Memorandum for John Rizzo, Senior Deputy General Counsel, Central Intelligence Agency, "Re: Application of 18 U.S.C. 2340-2340A to the Combined Use of Certain Techniques in the Interrogation of High Value al Qaeda Detainees," 10 May 2005. 163 Memorandum for John A. Rizzo, Senior Deputy General Counsel, Central Intelligence Agency "Re: Application of United States Obligations Under Article -16 of the Convention Against Torture to Certain Techniques that May Be Used in the Interrogation of High Value al Qaeda Detainees," 30 May 2005. 80 ':PQP Si:CRi:T I {(b )( 1) ~--~(b)(3) NatSecAct VWOli'OlUT I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct lOP SECRB1'/ /NOFORN//MR (b)(3) NatSecAct the program being acceptable because OMS said it was. The only OMS role, if and when Justice determined that any given technique was legal, was to insure the safety of the detainee-a responsibility as well shared by interrogators and other staff. The final DoJ memoranda stated that the legitimacy of the ROG program hinged on several-OMS relevant factors: ~OMS autonomy within the program; OMS· assurance that detainees would be adequately evaluated-physically and psychologically-prior to, during, and following any enhanced interrogations; the authority of OMS to stop or otherWise limit any ongoing interrogation, if medically indicated;~fil.ld the OMS experience that to date no medically significant aftereffects h~d;~t'~)'apparent in any previously interrogated detainee. A reliance on OMS was,»Pq~~f<>red by the inclusion c:if multiple quotations incorporated from the latest (Dec~lfor 20~~issuance of OMS Guidelines, and by many references to discussions wi$ OMS perso-!111~1. An illustrative excerpt, from the 10 May 2005 memoranda addressing intefrogation'tec~iques: ~··· ... , .t•.' • ,{,q> • "In addition, the involvement pfi!feqical an'1·psychologic~i ...;f_J:;' personnel in the adaptation and applicatio~~e. es1ablished SEREY techniques is particularly noteworthy for puri>os~s of our analysis. · Medical personnel have been'i»i'!ved in imposin$Hmitations'on-and requiring changes to--certain prin monitoring {jperieJ?.ce with the detainees, we understand that tH :~js~gfilar·r~g_rting on medical and psychological expel,lieg~e-\vith th~~fu~chWiques on detainees and that there are · sp€a°l ins1Mton.s on a~enting experience with sleep deprivation and ~ ~"' ,. . ~e waterboard.h.~JV1S has~sR~fically declared that "[m]ed1cal officers i:riftst-temain cogrli~t at ailttimes of their obligation to prevent ''.severe physical pain or suffering"[citation omitted]. In fact, we understand that medi~and psych~l~gical personnel have discontinued the use of . techniqti'es ~,..to ~ifariicular detainee when they believed he might suffer such pain dr:i~eB.ng, and in certain instances, OMS medical perso~el have not cleaj'e~ready had ruled that Agency techniques did not reach the threshold for the "cruel, inliuman, or degtjlding" treatments barred by the Constitution, and a new OTA requirement that Do.Q int~gation guidelines be followed was applicable only to DoD facilities, and not t6·~e.~t" Agency sites. Less reassuring was the way the OTA addressed the question of legal protections for those engaged in authorized interrogations. This stated that the U.S. Government "may" pay employee costs (including legal counsel) associated with civil action or criminal prosecution, and offered as an employable defense that "a person of ordinary sense and understanding would not know the practices ' were unlawful." .•::.:~~...!'.;.. '"'1·.' • • • • (b )( 1) (b)(3) NatSecAct 82 'f'9P S:SSR:S~/f(b)( 1 ) (b)(3) NatSecAct kn0Foru1 I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct 'l'Ol' SECREr/I ) r/NOFORN//MR. (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct . , ~:.':.· Over several months in the spring and summ~[.2Q06 an'OMS ::hysician escorted five detainees that required specialized ~uafi'en~r surgerJl 1!1'.11 ~o received this care. Additienally, during this penL,,·-0""'a~--a-.co-n_c_e_rt_ed~(b )( 1 ) · effort was made to move as many detainees a.,s~ · le ou~Agency han~®t theD (b)(3) NatSecAct still in RDG facilities in late February, half had be trans:terreq elsewhere ]:)y September, with most returned to their countries of origin. As ~· OMS personnel accompanied' all detainee movements"> .. (b)(1) (b)(3) NatSecAct I \: ~1>~ . ~ . ~::{~·~ In June, 2006, the Supreme Courtruled ·.it_t:flamden v. 'Rumsfeld that the military commission system then in place at Guaritlnam)~~~~er). · ~ . . :. ,:.. :,~~~:~-. . . iio. The M~~··estaplishecl"li· new system. of military tribunals and, consistent with Common:.Aiticle 3;· $.~nded the·War Crimes Act of 1996 to bar not just techniques that causaj;t;~evere physic~~ment~lf{i'ain?Or suffering" ("torture"), but also those which cau~~l°"s~v~e or seriou°1p~ysical Fmen:tal pain 9r suffering" (or "cruel or inhuman treatment")~No specific techniques were addressed; rather, the President was given authority to rii.QJljpecifica~ interpret the implications of the Comnion Article 3 through an Executive Order-. ,. ··~/' f Finally, the ¥CA strengthened the protections extended by the DTA to those involved in authorized interrogations prior to 30 December 2005. Employee costs incurred during any investigation or prosecution-in the U.S., abroad, or in international tribunals-would be paid by the U.S. government. During the summer 2006, a White House decision was made to transfer to . military custody at Guantanamo Bay the 14 HVDs (b )( 1 )_ _ _ _ _ _ _ _ _~ (b)(3) NatSecAct 83 . . f(b)(1) 'l'iF OBCRET/(b)(3) NatSecAct VHOFOH:U I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct '!'9P SEl€RE"f ~ r /li9FORU//HR (b)(3) NatSecAct (b )( 1) (b)(3) NatSecAct (b )( 1) (b )( 1) ~-----------------(b)(3) NatSecAct 3 (b)( ) NatSecAct Witllthe transfer of the 14 detainees to Guantanamo, Within a~f'i_e_w_m_o_n_th_s_,_a_n-ew-ly~ I . I (b )( 1) captured detainee· was transferred! ~dul Hadi al Iraqi, the designated (b )(3) NatSecAct replacement for Zarqawi as head of al-Qa'ida operations in Iraq. He had read of CIA interrogation methods, he said, and preferred just to cooperate without them. Whether or not he was truly forthcoming is unclear, but no enhanced inteq.©~n methods were employed. prior, to his transfer to Guantanamo Bay in Apri~ ~O°i:( b) ( 1) ., .. . ·"'- · ' I ' · .(~)(3) NatSecAct (b )( 1) (b)(3) NatSecAct_~-----------~-----~---~ There they were allo~ed to talk with ~o-ne_an_o~er-,-so_m_e~o-r~t~e~-rs-t~ti_m_e~i_n_s-ev-e-ra1~~~¥~ . e~.~~.s?~and ai~.o were interviewed,by the ICRC. Each was assigned a military lawyer to help"prepare for-.a tribunal h~ng on their · · status as illegal combatants. Were this status establi~h~l'they then faced prosecution for ·~:... '"#.their terrorist acts. , To date the Agency program had•plss~tthro·ugh two ~t discrete phases. The first period, from 2002 through 2004, WasJlrim~ly !?,~f..iyultiple successful interrogations. The seco~giod, from 2005 _tlftough 2006, was one of lengthening detentions. The character of~:>.: third period~is-as of sUlnmer 2007-still uncertain .. While the Agency ~U's~ended ~ofEITs follo~ng the December 2005 enactment of the DTA, it did not abande.n 'the notiO'n of playing upi.que role in the interrogation of HVDs. ,After reviewing the overaij,p,,tQgiiitjn"J~e. .~gep.cy sent DoJ a request to evaluate a much .reduced s~~>t~f Pr~p~~ "enh~qed" techniqpes, which did not incl~de walling, the · waterbo¥d, confinem~~oxes, .dousing, and stress positions'. The proposed array of techniques was limited t~ ~e thr~staolished conditioning techniques: nudity, dietary manipul~foq, and sleep ~privationr...and four of the five corrective techniques approved in 2005: fa~tal grasp, attenti:0..n grasp, abdominal slap, and facial or insult slap (but not walling). No"tOercive measmes were included. 164 The proposed upper .limit on sleep a deprivation remaitf"ed at 18f>hours, but with a new requirement that the detainee be reassessed after 96 h~ur8 and specifically re-approved for each additional 24 hours. OMS welcomed these changes as further limiting medical risks without appreciably weakening program effectiveness. In its view, interrogation success appeared to result prim!lfily from the three "conditioning" t~chniques proposed for I In contrast to the reality, a Newsweek "WEB EXCLUSIVE," 20 Sep~mber 2005, cited Senate staffers as saying the Administration were trying to redefine the Geneva limitations to allow seven techniques: 1) induced hypothermia, 2) long periods of forced standing, 3) sleep deprivation, 4) the "attention grab" (forcefully seizing the suspect's shirt), 5) the "attention slap," 6) the "belly slap" and 7) sound and light manipulation. 164 84 TQP ~1lCPET/j(b)(1) ~--~(b)(3) NatSecAct llNOFOPN I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) 'f'SF 81!!CRET J Nat~ecAct /I · r/MOfi'O!tM//M!l ·~I~~~(_b)_(3_)_N_a_tS_e_cA_c_t~~~- retention, particularly sleep deprivation. 165 Since to date only three detainees had been kept awake beyond 96 hours (and none as long as 180 hours), the proposal was entirely · consistent with ongoing practice. "Corrective" techniques also appeared to play a · synergistic role, but from the medical standpoint, walling was somewhat problematic because if not handled carefully could result in head contact with the wall. It also appeared less controlled than any other t~chnique, and infrequently required some medical intervention. 166 Elimination of all coercive measures, and walling, would appreciably simplify medical monitoring. D~~sions, . As previously, OMS was brought into these newest this time in the hope that a medical distinction was possible between "~~v. .er;e.;·., and "serious" physical and mental suf!ering. Thinki~~ this an entirely ~egal qu~y'rn, ®~.,declined t? speculate. Ultimat~ly, a provt_s1onal DoJ analysts fo~n:~'\.af:J~he_ r~~~~~~ techniqu_es legally acceptable, 1.e., they dtd not reach the thresqotd'"o'"senous" pa~~ suffenng. A definitive ruling awaited the underlying Executt~·fOrder ipterpreting ccfffim.on 1-rticle 3. OMS also contributed to this discussion, thraµgffl'·.Qriefing fc;>r DNI Admiii*Mike McConnell on medical support to the interrogatiorf'.ai)d det~nii·en program. . P . ....... ""'l .. The President's Executive Ortf~r. finally was rei~~s~ in mid-July 2007, prompted ~ (b)(1) by the desire to interrogate a key al-Q~i_ij.:tive, rec~i~c~mured and rendered~ (b)(3) NatSecAc,t This EO interpreted Common ~icle 3 as req1;1jJi6'g "the basic necessities of life, _including adequate food and wate\~helter- fi~the el_ements, necessary clothing, . protection from extreme~...qfpeat and cold,~d essenttalpical care." Barred were torture or other acts ~,ifip·ara~~ murder, to~re, mutiilation, cruel and inhuman treatment, or acts ~ftt,oiV!e or d~·gi;adation wha\~ r:asonable person would deem '_'beyond the bounds of human H~B~~cy."i ~eyond these 1JMP.lts, enhanced measures were sttll allowable, as was detenfio~.-~~?,ho~l?l1~~~ess. [NEED TEXT] ~ I ~ ~~ --..:7 E>~ertViihrnediately 1fil1Hu= followed this with concrete guidance largely unc~~ from that agr:e;t to irfci~,!!ef1tnd allowing sleep depriva~ion (as above), dietary man1pul~0n, and the sevt! requested slaps and holds. Only nudity had been chang~d-~~O:japering. · . I '/ Asked~,the ~live Order on NBC's "Meet the Press," Director of National Intell1genc!f:NI) Mike McConnell would not say exactly what would.be permitted, but he diqtfiighlight-as never publicly before-the medical role in the process: (b )( 1) (b)(3) NatSecAct 166 On two occasions detainees complained of potentially walling-associated memory or hearing loss, but a detailed evaluation at the time found both to be feigned symptoms. 85 IO!' S!!e~E'i'/ q~~g~ NatSecAct l/MeFeR:N I I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 · (b)(;:$) Nat~ecAct 'fOP OSECRE1/I ,' r/NOFOR!'J//MR (b)(3) NatSecAct " ... When I was in a situation where I had to sign off, as a member of the process, my name to this executive order, I sat down with those who had · been trained to do it, the doctors who monitor it, understanding that no one is subjected to torture. They're, they're treated in a way that they have adequate diet, not exposed to heat or cold. They're not abused in any way. But I did understand, when exposed to the techniques, how they work and why they work, all under medical supervision.'' 167 on!¥~i<,iate (At the time of this writing-September 2007-the to be interrogated under these new guidelines alleged the unusual~mbination of visual and . auditory hallucinations after just over I 00 hours of standing sie~cl~privation. As a result, he was allowed a 16-hour sleep break, but contin~ to claih; ·yisual hallucinations. A thorough psychological examination at that time.led-tchthe conclu~ion\that he was malingering. He was returned to intermittent sledfdeprivation, up to t~'8Q limit [over · ~y 30 days], but this did not achieve compliance.wi;~erro!~~~rs.. ) ......... Transcript, Mike McE~~ell interview on "Meet the Press," Tim Russert, Anchor, MSNBC.com, 22 July 2007. The possible interpretation that physicians were supervising the enhanced interrogations later . was addressed briefly by a McConnell spokesman who clarified that McConnell said that doctors would "monitor, not supervise" interrogations, but would not clarify if this referred to physicians, or how the monitoring would be accomplished, or if this was a new requirement. Spencer Ackerman, "(Re)Call the Doctor: Physicians Involved in CIA Interrogations?," TPMMuckracker.com, 23 July 2007. Russert, like many others, wanted to know what techniques could and could not be used (especially the waterboard), but . McConnell-like other Administration spokesmen-refused to specify on the grounds that this would allow training against the techniques, and "because they.believe these techniques might involve torture and they don't understand them, they tend to speak to us, talk to us in very-a very candid way." 167 86 'fOP f(b)(1) . NatSecAct SElCRE'i' /(b )(3) l/HOFORll I Approved for Release: 2018/08/13 C06541727 C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct '±'OP SEeft:!!'f /I r/NOPO!tM//Mll (b)(3) NatSecAct Interim .1fterthoughts (b)(3) CIAAct (b)(3) CIAAct (b)(3) CIAAct (b)(3) CIAAct Support to the RDG program may well be the most extensive operational commitment in the history of the Office of Medical Services. It certainly was one of the most intense. During the fivf vyrs from 2002 to 2007,I pMS staff officers ~)(3) CIAAct physicians, psychologists PA' s, and [}iurses) were dtrectly involved in the program. These officers evaluated, monitored and provided quality care to 97 detainees variously held in ten Agency facilities. They also accompanied well over a hundred detainee transfer flights. Their guidance and presence made possible one of the most successful counter-terrorist operations in the history of the Agency. D An enumeration of the intelligence take from the 9ramati~l!y successful ROG program is beyond the scope of this history. Over 8,Q~O intellig~~~reports were generated, which was half or more of all al-Qa'ida reporting during the period. Detaineeprovided information led directly to the capture of other key terrorists, av~~ several major terrorist attacks, and became a foundatjon .for the 9/1:1,postmortem filmlysis. Even in the face of crippling media leaks and widespreaa~~l~a~ism, the Agency (and Administration) remained unwiJling to abandon what~b'1'froven an invaluable tool. Whether a more circumscribed,futill:e.program will prove similarly valuable remains to be seen. Even with a retain~7ci3te\riness aggressiV,;lf~t seemingly effective techniques, this may not be possible. Eventually the Administration will be pressed t~ · , state publicly that certain.aggressive measut~§.,will not be used (thereby reassuring future detainees, to the detriment ofJQ.f:.process) ...~rippling.leaks will remain inevitable, and approved techniqu~howev~\tenign-eventually will become known and again be targeted by human ri~,activists: This could ~~ily lead to the elimination of all the syner~stic adj_~cts to sleep ~epri·~--~~d soi>limit sleep restriction that it rarely ~s effective. ~4'.:ditionallri, publ~~itY to date·wJill'have led to the d~velopment of effective 1 resistai:~'measures! 16 ai~ _sho"itf.tlie immediate prospects do not look promising. Taking a 1011.geltview, future tef.rorist use ofWMDs is viewed as inevitable; and such an attack woilldlikEY lead to anothe;_reevalµation of what interrogation measures are acceptable. Wh~~OM~ again iZ!pproached on this subject, this brief history may be of some value. A few pBhifs may be worth repeating. As OMS began this chapter, it could find no comparable reco~f.the somewhat related experiences of the Fifties, which would have been useful. Organizationally, OMS was som~what buried at the time in a shortlived but distracting'realignment with Human Resources. Operational requests regularly were addressed, but outside the paramilitary environment OMS was not then aggressively attempting to insert itself into operations. Thus, when OTS formulated its approach to detainee interrogation, there was no meaningful medical inp1:1t or review-and E.g., effective countenneas~es against such techniques as standing sleep deprivation were discussed within the Agency as early as the 1950s, and simply capitalize on the desire of interrogators not to inflict serious of lasting hann. DeJiberate "collapse" or a sophisticated but feigned hallucination will almost guarantee a reprieve which likely will defeat the interrogation process as used to date. 168 87 'fe~ SECRI3'i' I r(b)(1) ~(b )(3) NatSecAct VHOFO!Mi I Approved for Release: 2018/08/13 C06541727 I C06541727 Approved for Release: 2018/08/13 C06541727 (b)(;:$) Nat~ecAct /I r /MOfi'OltH//Mfl (b)(3) NatSecAct '.f0P :31!!e1t!!T interrogational excesses resulted. In.hindsight it's easy-though in the operational climate, perhaps unrealistic-to say that OMS should hav~ been more pro-active in obtaining and critiquing the relevant briefs. Once into this fast-moving program, OMS also fell short in allowing a requirement for thorough medical records to fall victim to operational expediency and the crisis of the day. While this soon was corrected, it also was avoidable. Finally, as OMS increasingly was recognized for its vital contributions, there seemed to be a risk that too much of the program's legal justification would become OMS-based. While this issue was attended to, in view of the unique ethical issues involved it was a source of continuing concern .. ... #". . . I (b)(3) CIAAct I' (b)(6) A last word on ethics. The more proscriptive stand~,ttik~n by professional organizations since 2006 will pose potential dilemmas for OMS professionals supporting detainee operations in the future. The OMS officers ~ho previous1'.~~rked in this program confronted less concrete "ethical" issues, b.:Uf nonetheless invotved themselves because they thought it was the right thing to do,1and because of their tr\J~fi~d respect for those already involved. [}1s may have been rei)resentative in viewing th~~J~gitimacy­ i.e., ethics-of the program as dependent on it being legal; effective, safe and necessary. Necessity required solid evidence that interrogation carid:fifates possessed critical, timeperishable information unobtainable through less aggre'Psi\re alternative measures. DoJ affirmed legality. The empirical reco~ffumed effectiveness and, through the presence of OMS, the safety of the program. Finhl)y, Jfili.caiity and urg~ each received caseby-case analysis from CTC. Though imperfect Uris review nonetheless limited the application of EITs to le~s»Wf!. a third of th~?'detain~wbo came into Agency hands, and further .limited ~eflne most aggressiv~~ techniquJ to only 5 or 6 ofthe highest value detainees. Ap'Ei:iterion of''necessity" alt~.requires that no aggressive measure be used when a lesser measure wo~lp suffice. For a variety of reasons, the program initially was ill-prepared to make thi~judgi]Jeat-;--but experiences during the first year had it well . way to-~ J!'!.llllilla ....,..... l"1st ap~r;..e.ac ~ h. & -~.~~ on its $ . . ·:if'~ .&:'.~ ,-~... '"" ·:a . ,..~ . ~ ... ·'I-.. ~·· ,, 88 J(b)(1) !OP SECltB'f I (b)(3) NatSecAct Approved for Release: 2018/08/13 C06541727