Marooned at Guantanamo: Aging inmates face medical issues

For 162 detainees of American detention complex, long-term imprisonment requires increasing attention to health care

Visits to the prison by outside physicians have become routine over the past few months.
Joe Raedle/Getty Images

GUANTANAMO BAY, Cuba — The inmates of the detention center here were once considered the "worst of the worst" in the "war on terror." U.S. officials locked away hundreds of men picked up all over the world in a belief that they were all hardened enemies of America, ruthlessly committed to their cause.

But now, more than a decade later, many of the remaining detainees — the vast majority of whom have never been charged, and scores of whom have been cleared for release — are ailing as they get older behind bars. Their physical and mental health after years of captivity, often marked by hunger strikes, now requires frequent medical attention.

This week, an ophthalmologist was flown from the U.S. to the naval base to perform cataract surgery on two prisoners who have been held without trial for more than a decade. Navy Lt. Cmdr. William Greg, the officer in charge of the 15-bed detainee hospital, told Al Jazeera that visits to the prison by outside physicians have become routine over the past few months.

“As people age, there’s medical problems,” said Greg, a nurse who was deployed to Guantanamo two months ago. “For example, we just brought in a gastroenterologist to see our patients. We also just had a dermatologist here.”

There were no prisoners at the hospital when Al Jazeera toured the site. Greg said he does not see the most high-value prisoners — including Abu Zubaydah and Khalid Sheikh Mohammed, the self-professed mastermind of the 9/11 attacks — who are held in a top-secret camp at an undisclosed location on the base.

Greg said he is not authorized to disclose the identities of the prisoners undergoing surgery, because of privacy concerns. But he said he and the staff of the Joint Medical Group at the base have been treating prisoners who are battling problems ranging from obesity and diabetes to depression.

In fact, at least one prisoner has become so concerned with his diabetic condition that he requested the book “Diabetes for Dummies” from the detainee library, according to a library technician, Milton (who, like numerous other contractors who support the prison operations, would not disclose his surname for security reasons).  

Some upgrades are currently underway at the hospital and the neighboring Behavioral Health Unit, but the facilities are aging.
Jason Leopold/Al Jazeera America

How to close Guantanamo, where 162 prisoners are currently being held, is not the only crisis the Obama administration and lawmakers on both sides of the aisle have been forced to address. Earlier this year, Rep. Adam Smith, D-Wash., raised concerns that the failure to provide older prisoners with better medical care could open the U.S. government up to “all kinds of implications in terms of human rights violations that we would have with our own laws as well as international laws.”

"As the law stands now, and we have an inmate who has a heart attack, doesn't die, but needs more complicated care, where's he going to get it in Guantanamo?" Smith said during a hearing centered on a budgetary request to upgrade prison camp facilities. "He's not."

The hospital and the neighboring structure, the Behavioral Health Unit, better known as the psych ward, are located inside Camp Delta, where hundreds of prisoners were once detained. Those facilities, with their rusty exteriors, are showing signs of age.

Greg said that while some upgrades are currently underway at the hospital that may address Smith’s fears, the issue is still of major concern to him.

“We can’t staff for every specialty here,” he said, adding that some prisoners “need more medical care, and we’re trying to give it to them here. They’re getting older. We do the best we can.”

Surgeries for ailments such as cataracts are performed at the naval hospital on base because the detainee hospital is not equipped to handle them and there is no surgeon on staff. 

Officials no longer disclose how many inmates are on hunger strike. Here, a restraint chair used for force-feeding.
Jason Leopold/Al Jazeera America

But there is one thing the hospital is well equipped to handle: the force-feeding of hunger strikers. Greg has conducted dozens of such sessions. Standing in a room outfitted with a restraint chair and force-feeding kit, he described the procedure in clinical language and used the term “self-fast” when speaking about prisoners who refuse food as a form of protest.

“If a detainee is losing weight because of a self-fast, we want to make sure they are getting nourishment by putting a tube down the throat and nose so we can do an e-feeding,” he said, holding the tube and a bottle of liquid food.

“Before we do (a force-feeding), we’re going to offer them a meal tray. And if they still refuse the meal tray, we’ll offer them a nutrition shake. And if they refuse the nutrition shake, then a medical provider will select a type of feeding we can give them.

"A nurse will put the tube down their nose, and we will use olive oil or some type of lubricant. It seems that the detainees prefer the olive oil. We want to make sure we keep them as healthy as possible.”

Neither Greg nor the senior medical officer at the hospital, a physician who would not provide his name for security reasons, is concerned about the criticism the procedure has received from medical ethicists and human rights groups.

“Lots of groups have opinions about how they feel about what’s going on,” the senior medical officer said. “That’s very reasonable. Everyone has an opinion, and I respect that. Still, we need to get the mission done, and our mission of trying to ensure the detainees under our care are getting healthy is our primary goal.”

A nurse will put the tube down their nose, and we will use olive oil or some type of lubricant. It seems that the detainees prefer the olive oil.

Lt. Cmdr. William Greg

Officer in charge of detainee hospital

Both Greg and the senior medical officer refused to disclose the number of prisoners currently on hunger strike, in keeping with a newly implemented media blackout policy on the details. The senior medical officer disputed claims that the hunger strike has escalated. Last week, British prisoner Shaker Aamer told his attorney Clive Stafford Smith that the hunger strike is “back on” and involved 29 protesters — of whom 19 were subjected to force-feeding.

“I’ve seen a steady decrease in the number,” said the senior medical officer, who added that the force-feeding process was largely problem-free. “There have been a couple of detainees who are approved for enteral feeding who do resist the initial … being brought into the restraint chair. After that, generally speaking, they are sitting compliant and receiving their enteral feeding. There have been times when there has been some acting out, but usually it is relatively passive.”

Members of the medical staff provided identical responses to several specific questions, appearing somewhat rehearsed. Indeed, they said the medical conditions and quality of health care they have been providing to the prisoners are identical to what their patients receive in the U.S. All interviewees said that, with the exception of force-feeding, the prisoners have complete autonomy over their medical care.

“Prior to getting here I had no idea what to expect,” the senior medical officer said. “Getting down here and seeing what’s going on and how the medical care is delivered … it was eye-opening to see it’s pretty much the same as you would see anywhere. Obviously there are some logistical differences, such as the detainees requiring guard staff for movements.”

A psychiatrist, who also declined to be identified for security reasons, agreed. She said she has been treating prisoners who are suffering from depression and anxiety.

“I’ve seen here the same ailments I would see in a standard clinical practice,” she said. “It’s relatively similar, with the exception of the setting.”

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