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Yesterday, I wrote a diary detailing evidence that accused terrorist Abd al-Rahim al-Nashiri (al-Nashiri) may have suffered a specific physical injury due to combinations of enhanced interrogation techniques when he was a CIA detainee.  This analysis was in part based upon the recently released transcripts from the 2007 Guantanamo military tribunals (CSRTs) detailing the charges against several "high value" detainees, including the three known to be waterboarded, Abu Zubaydah, Abd al-Rahim al-Nashiri (al-Nashiri), and Khalid Sheik Mohammed (KSM).

Today I extend this analysis to Abu Zubaydah, exploring evidence that Zubaydah may have endured severe physical or psychological suffering during CIA interrogation.

On Friday, June 18, the CIA Inspector General's report from May 2004 will be released.  Whether this document will be extensively redacted is still unknown.  The unredacted version of the report is reported to reveal the consequences of harsh detainee treatment that helped lead to the withdrawal of the Yoo-Bybee torture memos in 2004.

In the meantime, the ACLU recently obtained previously classified CSRT transcripts which contain some information about detainees' medical conditions.

Accused top Al Qaeda operative Abu Zubaydah was captured in Pakistan in March, 2002.  In August 2002, he became the first detainee waterboarded in CIA custody, and is known to have been waterboarded 83 times.  I have pointed out that following Zubaydah and al-Nashiri's waterboarding, the CIA made dramatic changes to the "enhanced interrogation" program.  Specifically, they:

  1.  Ended all videotaping of interrogations.
  1.  Changed the rules for interrogation (two memos in January, 2003), requiring more headquarters control over when the harsh techniques could be used, and required field agents to sign the policy.
  1.  Added requirements for medical and psychological personnel on scene.
  1.  Initiated an internal Inspector General review of the program.

Two pieces of evidence have suggested that Zubaydah suffered a medical adverse event related to waterboarding:

Firstly, a partially redacted footnote on page 15 of the "2005 Bradbury Memo" (PDF) discusses what appears to be a near-death episode excerpted from the CIA Inspector General report:

In our limited experience, extensive use of the waterboard can introduce new risks.  Most seriously, for reasons of physical fatigue or psychological resignation, the subject may simply give up, allowing excessive filling of the airways and loss of consciousness. An unresponsive subject should be righted immediately and the interrogator should deliver a sub-xyphoid thrust to expel the water.  If this fails to restore normal breathing, aggressive medical intervention is required. Any subject who has reached this degree of compromise is not [censored hereafter].

Zubaydah and KSM are the only detainees known to undergo "extensive waterboarding" by the CIA, and KSM was waterboarded differently than Zubaydah (KSM had medical personnel in the room, see below). Indeed, we find in a second document that Zubaydah is the only detainee who reported losing control of his bowel or bladder function or his consciousness during his interrogation.  From the leaked International Committee of the Red Cross (ICRC) report on "High Value" Detainees ("ICRC Report (PDF)"), Zubaydah described his interrogation including waterboarding:

On this occassion my head was in a more backward, downwards position and the water was poured on for a longer time. I struggled without success to breathe. I thought I was going to die.  I lost control of my urine. Since then I still lose control of my urine when under stress.

<snip>

I collapsed and lost consciousness on several occasions.  Eventually the torture was stopped by a doctor.

Thus it appears the IG report footnote is referring to a waterboarding "ADVERSE EVENT" of Zubaydah that required resuscitative medical intervention.


CSRT Testimony

We now come to the CSRT testimony of Zubaydah from 3/27/2007.
Firstly, Zubaydah's personal representative notes his difficulty speaking:

No, Sir. Mister President, I would like to request that the Tribunal Members be patient given the Detainee's difficulty with speaking. Please be patient to any responses he may have to your questions.

Physical causes of difficulty speaking are numerous.  Considering some of what we know about CIA enhanced interrogation techniques, there are some possible explanations. If he was hoarse, this could reflect old laryngeal injury from tracheotomy or intubation that might have been part of resuscitation efforts.  Difficulty speaking could also be due to brain injury, such as from trauma, hypoxia, or fluid shifts from water intoxication.  There is also the possibility that psychological issues are contributing to his difficulty speaking.

On p22 of his CSRT transcript a redacted line precedes a sentence in which he notes suffering recurrence of symptoms he had previously after a 1992 head injury "including the complete loss of my memory and an inability to speak, read,or write."

Old brain injuries could re-manifest with additional brain injuries, such as from new trauma, hypoxia, or fluid shifts from water intoxication. Knowing the contents of the redacted sentence might shed light on possible reasons for recurrence of his prior brain injury symptoms (For example, attribution to walling versus waterboarding).

Zubaydah also describes "seizures" that he attributes to "mental anguish" relating to the fact that the CIA confiscated his personal diaries.  These could be epileptic or behavioral, it is unclear.  Risk for epileptic seizures is increased following brain injury, so he certainly has risk factors for epileptic seizures antedating his capture as well as potentially from his capture and interrogation.  It is also possible that his seizures are behavioral, or non-epileptic:

When I came here I ask about it [his diary] again and again. I do not whose take it; [redacted] I was only thinking — thinking I found myself I found myself fell down. They not believe in the beginning but the specialist doctor they tell me yes most of the seizure he have he bring it for himself by that think.

This suggests that a "specialist", potentially a neurlogist, believed that the seizures were due to anxiety over the loss of his diaries.  While epilepsy can certainly be exacerbated by anxiety, seizures triggered reliably by anxiety are more often non-epileptic.  Numerous psychological factors can contribute to non-epileptic seizures, including depression and post-traumatic stress disorder (PTSD).  He is reported to be taking the antipsychotic medication, Haldol, consistent with treatment for psychiatric illness. Whether he had an electroencephalogram (EEG) is unclear, but that would be part of an appropriate evaluation for seizures.  Haldol would not be a suitable medication for treating epileptic seizures.

Another medical issue revealed in the CSRT testimony is that Zubaydah has discomfort in his feet:
He is noted to use his prayer cap as a sock to warm up his foot:

I need to cover my-this thing, I used the, what this [Detainee removes his left shoe and extracts a prayer cap] what we use it for pray to, I request them give me socks; this is too much cold I feel twenty four hours even in the very hot time since I have the injury

and again:

In these two fingers or three fingers [sic], [Pointing to his
feet] it's too cold. I didn't know what how to say it in English Twenty Four Hours.

It is unclear from the testimony and reporter descriptions whether Zubaydah is complaining of discomfort in both feet or only his left foot.  The symptoms he is reporting are consistent with a neuropathy- injury to a nerve or nerves- which often results in abnormal sensations in the affected nerve distribution.  We are aware of injury to Zubaydah's left thigh at the time of capture, which might have included nerve injury to explain problems with sensation in his left foot.  If there are symptoms in both legs unexplained by his injury at capture, another potential cause of nerve injury to consider is compartment syndrome.  I speculated yesterday that another detainee, al-Nashiri, might have suffered nerve injury from a dangerous combination of fluid restriction and prolonged standing (resulting in leg edema), and water intoxication from waterboarding.  Because Zubaydah was subjected to all of the CIA's enhanced techniques and was waterboarded with bottled water, neuropathy from compartment syndrome might also explain some of his current symptoms.


Significance

It is very important to caution that this interpretation is based on very limited information, and is such pure speculation (albeit by a physician).  There are many questions that could be answered by review of medical records and by objective examinations of the detainees.  I am hopeful that the upcoming CIA OIG report release may help clarify some of these issues, but I am somewhat concerned that persistent redactions might hide descriptions of the physical consequences of "enhanced techniques".  

With specific regard to Abu Zubaydah, his testimony makes one thing clear; He had an old brain injury that caused mental dysfunction, "including the complete loss of [his] memory and an inability to speak, read, or write."  With an old brain injury, he was at increased risk for new brain injury. The Bybee memo was thus wrong when it asserted that Zubaydah had no known risk for mental or psychiatric pathology.  This adds to the evidence that either the CIA misrepresented Zubaydah's history and condition or the OLC chose to memorialize only the parts they needed.

Originally posted to drational on Wed Jun 17, 2009 at 07:24 AM PDT.

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