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Senate report: Uncooperative terrorism suspects faced rectal rehydration, feeding Senate report: Uncooperative terrorism suspects faced rectal rehydration, feeding
(about 1 hour later)
Among the more jarring passages in the Senate Intelligence Committee’s report on CIA interrogations of terrorism suspects are descriptions of agency employees subjecting uncooperative detainees to “rectal rehydration” and “rectal feeding.”Among the more jarring passages in the Senate Intelligence Committee’s report on CIA interrogations of terrorism suspects are descriptions of agency employees subjecting uncooperative detainees to “rectal rehydration” and “rectal feeding.”
The report said that at least five CIA detainees were subjected to rectal rehydration or rectal feeding without documented medical necessity, while other detainees were threatened with the procedure. The report said that at least five detainees underwent the procedures without documented medical necessity and that others were threatened with them. While the CIA defended its approach, the techniques are all but absent from modern medicine.
At one point, Abd al-Rahim al-Nashiri, a Saudi citizen who allegedly masterminded the bombing of the USS Cole, launched a short-lived hunger strike, which resulted in the CIA force feeding him rectally, it stated. “For all practical purposes, it’s never used,” Thomas Burke, a Harvard Medical School professor and emergency physician at Massachusetts General Hospital, said in an interview. “No one in the United States is hydrating anybody through their rectum. Nobody is feeding anybody through their rectum. . . . That’s not a normal practice.”
According to the report, Khalid Sheikh Mohammed also was subjected to rectal rehydration with no documented medical need for the procedure. An interrogation official later characterized the measure as illustrative of his “total control over the detainee.” He added that he had polled more than a half dozen colleagues with decades of clinical experience and that none had ever employed it.
The practice of rectal feeding and rehydration, while not unheard of, seems to have received little attention in modern medical literature, and certainly not in the context of treating obstinate prisoners. Rectal hydration was used on wounded soldiers in World War I. In 1881, President James A. Garfield’s doctors tried to feed him rectally as he lay dying from an assassin’s bullet. He received egg yolks, milk, whiskey, beef bouillon and drops of opium in this manner, although he continued to waste away, according to a biographer.
Traditionally, it has been used only in dire circumstances, such as in the treatment of a 21-year-old man who was discovered by trekkers to be suffering from shock in the mountains of Nepal. President James Garfield’s doctors decided to feed him rectally as he lay dying from an assassin's bullet — he received egg yolks, milk, whiskey, beef bouillon and drops of opium in this manner, though he continued to waste away, according to a biographer. Some German psychiatric patients who refused food in the 19th century apparently were subjected to the practice. More recently it has been used only in dire circumstances, such as in the treatment of a 21-year-old man who was discovered by trekkers to be suffering from shock in the mountains of Nepal, according to a 2005 paper.
Tuesday’s report detailed a new twist on an old practice. But Tuesday’s report detailed a new twist on an antiquated procedure.
[Read: Senate Intelligence Committee’s full report] Abd al-Rahim al-Nashiri, a Saudi citizen who allegedly masterminded the bombing of the USS Cole, launched a hunger strike that resulted in the CIA force-feeding him rectally, the report stated. Khalid Sheik Mohammed, the architect of the 9/11 attacks, also was subjected to rectal rehydration with no documented medical need, the report said. An interrogation official later said the measure demonstrated his “total control over the detainee.”
According to the Senate report, one of the detainees who underwent the procedure was Majid Khan, a Pakistani citizen and former resident of the Baltimore suburbs, who pleaded guilty in 2012 to five war crimes, including murder, attempted murder and spying. He previously had been held by the CIA at a secret prison overseas for three years before his transfer to the U.S. military facility at Guantanamo Bay. He claimed he was “mentally tortured” by the agency and twice attempted suicide. Another detainee who apparently underwent the procedure was Majid Khan, a Pakistani citizen and former suburban Baltimore resident, who pleaded guilty in 2012 to five war crimes, including murder, attempted murder and spying. He was held by the CIA overseas for three years before being transferred to the military facility at Guantanamo Bay. The report said Khan was subjected to “involuntary rectal feeding and rectal rehydration,” which included two bottles of Ensure. Later that day, his “lunch tray,” consisting of hummus, pasta with sauce, nuts and raisins, was pureed and “rectally infused.”
The report said Khan was subjected to “involuntary rectal feeding and rectal rehydration,” which included two bottles of Ensure. Later the same day, his “lunch tray,” consisting of hummus, pasta with sauce, nuts and raisins, was pureed and “rectally infused.” CIA medical officers discussed rectal rehydration as a form of behavior control, according to the report, with one officer writing, “[w]hile IV infusion is safe and effective, we were impressed with the ancillary effectiveness of rectal infusion on ending the water refusal in a similar case.”
The report also said CIA medical officers discussed rectal rehydration as a form of behavior control. According to the report, one officer wrote, “[w]hile IV infusion is safe and effective, we were impressed with the ancillary effectiveness of rectal infusion on ending the water refusal in a similar case.” The same officer, the report said, wrote: “[r]egarding the rectal tube, if you place it and open up the IV tubing, the flow will self regulate, sloshing up the large intestines.” Referencing the experience of the medical officer who had subjected Mohammed to rectal rehydration, the officer wrote: “[W]hat I infer is that you get a tube up as far as you can, then open the IV wide. No need to squeeze the bag — let gravity do the work.”
That same officer, the report stated, provided a description of the procedure, writing to a colleague, “[r]egarding the rectal tube, if you place it and open up the IV tubing, the flow will self regulate, sloshing up the large intestines.” Referencing the experience of the medical officer who had subjected Khalid Sheikh Mohammed to rectal rehydration, the officer wrote: “[W]hat I infer is that you get a tube up as far as you can, then open the IV wide. No need to squeeze the bag — let gravity do the work.” In a June 2013 response, the CIA insisted that agency medical personnel on scene during interrogations monitored detainees’ hydration and food intake to ensure that they “were physically fit and also to ensure they did not harm themselves.”
In a June 2013 response to the findings, the CIA insisted that agency medical personnel on scene during enhanced technique interrogations carefully monitored detainees’ hydration and food intake to ensure that they “were physically fit and also to ensure they did not harm themselves.” There has been a history of detainees going on hunger strikes. Earlier this year, a federal judge ruled that the military could force-feed a Syrian detainee to prevent him from dying, though she urged authorities to consider alternative methods.
There has been a history of detainees going on hunger strikes. Earlier this year, a federal judge ruled that the military could force feed a Syrian detainee to prevent him from dying, though she urged authorities to consider using alternative methods. The CIA said that personnel who administered rectal rehydration did not do so as an interrogation technique or to degrade a detainee, but rather because it was “a well acknowledged medical technique to address pressing health issues.” The agency dismissed the suggestion that the practice was used to assert “total control” over detainees, saying that “a single flippant, inappropriate comment by one CIA officer concerning the technique, quoted in the study, is not evidence to the contrary.”
The agency said dehydration was relatively easy to assess and was considered a very serious condition, and that personnel who administered rectal rehydration did not do so as an interrogation technique or to degrade a detainee, but rather because it was “a well acknowledged medical technique to address pressing health issues.” The agency also argued that the practice was “deemed safer” than using IV needles with noncompliant detainees, and more efficient than forcing a feeding tube through a detainee’s nose, down his throat and into his stomach. The CIA said that Khan had removed his own feeding tube, “which posed the risk of injury and other complications.”
The CIA also dismissed the suggestion that the practice was used to assert “total control” over detainees, saying that “a single flippant, inappropriate comment by one CIA officer concerning the technique, quoted in the study, is not evidence to the contrary.” But Burke, the Harvard medical professor, said that explanation falls short. Every day in the United States, health workers encounter uncooperative, belligerent or mentally disturbed patients who need hydration or sustenance. “And [in] none of them do we put a tube in their bottom,” he said.
The agency also argued that the practice was “deemed safer” than using IV needles with noncompliant detainees, and considered more efficient than forcing a feeding tube through a detainee’s nose, down his throat and into the stomach. The CIA said, for example, that Khan had removed his own feeding tube, “which posed the risk of injury and other complications.” Given that behavior, officials said, “rectal rehydration was considered the most appropriate means of addressing the potential harm Khan might inflict on himself.” Burke said the idea of hydration is plausible, because the colon can absorb water. But the notion of feeding a person rectally has little physiological basis. “It doesn’t make any sense,” he said.
Thomas Burke, a Harvard Medical School professor and emergency physician at Massachusetts General Hospital, said Tuesday that rectal rehydration essentially involves a very mild enema used to put water into the rectum. “What we can say is that because nobody [in the medical field] would do it, it has to lead to the question of what were they really doing?” he said. “We deserve a better explanation.”
“It is indeed a way that can be used for rehydration in emergencies, but I’m certain that’s not what was used in this particular case,” he said in a brief call from rural Kenya. “It was probably high pressure and inflicted significant pain.”
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