DEPARTMENT OF THE ARMY 

OFFICE OF THE SURGEON GENERAL 

5109 LEESBURG PIKE 

FALLS CHURCH, VA 22041-3258 

MCJA 

MEMORANDUM FOR RECORD 

SUBJECT: Approval of Findings and Recommendations of Functional Assessment 

Team Concerning Detainee Medical Operations for OEF, GTMO, and OIF 

1. I have reviewed the findings and recommendations of the assessment team 

concerning detainee medical operations for OEF, GTMO, and 01F and the legal review 

of that report. 

2. 1 hereby approve all the findings and recommendations except the recommendation 

that psychiatrists/physicians not be used as members of a Behavioral Science 

Consultation Team (BSCT) and that all detained individuals be treated to the same care 

standards as U.S. patients in the theater of operation. Idirect that these 

recommendations be further reviewed to determine whether these recommendations 

should be approved. 

3. 1 also direct the MEDCOM Staff Judge Advocate to make appropriate coordination 

with the Army Inspector General's Office concerning the alleged misconduct of two 

senior officers pursuant to paragraph 8-3, AR 20-1. 

4. Lastly, I direct that the MEDCOM Staff Judge Advocate coordinate with the 

appropriate Command/lnvestigative Organization to determine the final dispos~tion of 

the other three incidents that were previously referred by the assessment team for 

appropriate action. 

Lieutenant General U 

The Surgeon General 
21905 

Surgeon Gene 

VA 220.41-332 

SUBJECT: Assess edrcal Oiperatrons for OEF, 

1. Reference Me ,TSG, Army, Subject: Appoint t as Team Lea 

Functional Assessment:Team, dated 12 Nawem 

rt documents the assassment of detainee m dim1operations for 

lOlF ~ompleteddurjng he peri er 2904 to13 April 

s a table of reported 

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ENCL 
FINAL REPORT 


ASSESSMENT OF 


DETAINEE MEDICAL OPERATIONS 


FOR 


OEF, GTMO, AND OIF 


OFFICE OF THE 


SURGEON GENERAL 


ARMY 


13 April 2005 

TABLE OF CONTENTS 


TOPIC PAGE 

Executive Summary 1-1 

Background 2-1 

Methodology 3-1 

Question a. What units provided medical care to detainees in OEF and OIF and 4-1 

what was the period of service for each unit? 

Question b. At what location did each unit provide medical care (e.g., MTF, 5-1 

detainee facility, and interrogation facility)? 

Question c. What MOS and OBC training or other school training did the 

medical personnel serving in these units receive regarding the generation, 

storage and collection of detainee medical records and regarding the medical 

reporting of detainee abuse? 

Question d. Was there any policy guidance, OPORDER, SOP, or other 

authority establishing criteria for providing detainee medical support and/or care 

in the theater of operation? 

Question e. What unit training did the active component receive prior to 

deployment regarding the generation, storage and collection of detainee 

medical records and the medical reporting of detainee abuse? 

Question f. What training did reserve component soldiers receive at home 

station, power projection platforms and in-theater regarding the generation, 

storage and collection of detainee medical records and the medical reporting of 

detainee abuse? 

Question g. Identify OEF and OIF detention medical facilities. 

Question h. With respect to the detention medical facilities identified in 

subparagraph 2g immediately above, determine if the facility generated, stored 

and collected detainee medical records, to include records documenting medical 

support to any detainee being prepared for interrogation, being interrogated, or 

needing medical treatment as a result of, or immediately after, interrogation. 

Question i.With respect to those detention facilities that kept medical records, 

did medical personnel properly generate, store and collect appropriate medical 

records of detainees? 

Question j. With respect to those detention facilities that kept detainee medical 

records, identify the location where the original and any copies of the records 

are maintained. 

Question k. Were any medical personnel aware of, or treat injuries related to, 

actual or suspected detainee abuse? 

Question I.Did any medical personnel aware of, or who treated actual or 

suspected detainee abuse properly document the abuse? 

Question m. To whom did any medical personnel aware of, or who treated, 

detainee abuse report such abuse? 

Question n. Were there any theater or unit policies or established SOPs/TTPs 

that specifically required medical personnel to report detainee abuse? 
1 OTHER ISSUES 1 18 11 

Overview of Site Visits to Afghanistan (OEF), Cuba (GTMO), and Iraq I (OW 18-I ~z

I OIF Theater Preoaration for Detainee Care 1 18-3 18 11 i Medical screeniAg and Sick Call at the DlFs and Prisons i 18-6 'wii I Restraintslsecurity 1 18-9 18 11 

I Medical Personnel Photoaraohina Detainees 1 18-10 1811 

The Use of Behavioral Science Consultation Teams (BSCT) in the 'I 

", " 1 18-12 '18'1 

Interrogation Process 

I Medical Personnel Interactions with Interrogators 1 18-16 1811 

I Stress on Medical Personnel Providing Detainee Medical Care 118-22 18 11 

I lnterviewee Training Requests 1 18-25 1811 

I Non-AMEDD Training 1 19-1 1911 

I Incidents and Allegations I D!a I Explanation 

I lncidents and Alleaations Table " I Citations in the Report 1 21-1 2111 I Glossary of Terms 1 22-1 2211 I Exhibit A. I 1 23 11 I Appointment Memo 1 23-1 23 11 

Team Appointment Memo 1 23-5 23 1 

Aooointment E E as Actina Adjutants " , 1 23-6 k/ / Exhibit B. Assessment Team Biosketches / 24-1 IF//

I Exhibit C. Questionnaires 2511 

I Annex 1 - Interview Script 1 25-1 25 11 

I Annex 2 - Questionnaire Cover Sheet 25-3 2511 

I Annex 3 -Privacy Act Statement 1 25-4

I Annex 4 -PastIPresent Questionnaire Questions wpq I Annex 5 -Future Questionnaire Questions 1 25-14 2511 i Annex 6 -PPPICRC Questionnaire 

Annex 7 -BSCT Questionnaire Questions 

I Annex 8 -Student Questionna~re 1 25-24 2511 

I Annex 9 - JRTC Questionnaire i 25-25 mi 

I Exhibit D. Summary of Recommendations 

I Exhibit E. List of References Reviewed bv the Team 
ASSESSMENT OF DETAINEE MEDICAL OPERATIONS 

FOR OEF, GTMO, AND OIF 

OFFICE OF THE SURGEON GENERAL, ARMY 

13 APRIL 2005 

EXECUTIVE SUMMARY 

On 12 November 2004, The Army Surgeon General, LTG Kevin C. Kiley, directed the 

Commander of the U.S. Army Medical Research and Materiel Command, MG Lester 

Martinez-Lopez, to lead a multidisciplinary Functional Assessment Team (the Team) to 

assess detainee medical operations in Operation Enduring Freedom (OEF), 

Guantanamo Bay, Cuba (GTMO) and Operation Iraqi Freedom (OIF). LTG Kiley 

specifically directed the team to look at 14 assessment questions with respect to Army 

active component (AC) and reserve component (RC) medical personnel providing 

support and/or care to detainees in Afghanistan, Cuba, and Iraq. In formulating the 

assessment approach, the team reviewed previous assessments related to detainee 

operations and investigations of detainee abuse, as well as policies, regulations, and 

field manuals outlining the precepts of detainee operations. The medical assessment 

focused on aspects related to: (1) detainee medical policies and procedures, (2) 

medical records management, and (3) the incidence and reporting of alleged detainee 

abuse by medical personnel; the fourth focus area of training medical personnel for the 

detainee health care mission was addressed within focus areas (2) and (3). 

The Team found a dedicated and committed cadre of medical personnel whose goal 

and desire were to provide high quality healthcare for each patient they treated, 

regardless of status. While medical personnel faced numerous challenges in a stressfilled environment, the interviewees continually described the compassionate and 

dedicated care they provided to detainees. Many medical personnel described the 

extraordinary measures and efforts put forth to care for and save the lives of detainees. 

Our medical Soldiers represent the best our country has to offer and they truly gave of 

themselves to serve our Nation. 

Methods 

The Team interviewed medical personnel in maneuver, combat support, and combat 

service support units in 22 states and 5 countries. The interviewees were preparing to 

deploy (future), had previously deployed (past), or were currently deployed (present) to 

OEF, GTMO, or OIF; they included AC and RC (U.S. Army Reserve (USAR) and 

National Guard (NG)) personnel. For the current interviews, the Team visited the 

detention medical facilities at Bagram, Afghanistan and Guantanamo Bay, Cuba, and in 

Iraq, the Team met with the Commander, Task Force (TF) 134 (TF responsible for 

detainee operations), and interviewed medical personnel supporting detainee 

operations at Abu Ghraib, Camp Danger, Camp Liberty and Camp Bucca. In Kuwait, 
the Team met with the Combined Forces Land Component Command (CFLCC) Deputy 

Commander and Chief of Staff, as well as the CFLCC Surgeon, to gain a perspective on 

the planning factors for detainee medical operations. For the past and future interviews, 

the Team traveled to units in 22 states and Germany. A leadership perspective on the 

issue of detainee medical operations was gained through interviews with medical 

personnel from command and control elements at corps, theater, and level I, II and Ill 

medical units. For training interviews, the Team visited faculty and students of training 

programs at the Army Medical Department Center and School (AMEDDC&S), and 

trainers at the Military Intelligence (MI) School, National Training Center (NTC), Joint 

Readiness Training Center (JRTC), Continental U.S. Replacement Centers (CRC), and 

12 Power Projection Platform (PPP) sites. Additionally, lesson plans and other training 

materials were reviewed at these training sites. 

Units 

The identification of each unit, the location in theater, and personnel providing medical 

support to detainees for OEF and GTMO was more easily discernable than for the OIF 

theater. In OIF, more than 50,000 detainees have moved from point of capture and 

collection points, through brigade (Bde) and division internment facilities, to the major 

prison facilities. Due to the rapidly evolving operational environment, medical personnel 

served in numerous locales in the OIF theater and provided detainee medical support 

across the continuum of care, ranging from medical screening to acute trauma 

management, evacuation, and long-term rehabilitative and chronic disease care. 

Interviews 

A total of 1,182 personnel were queried, from over 180 military units, in the following 

categories: 

For the pastlpresentlfuture personnel, 993 interviews (80%AC18%USAR/12%NG) 

encompassed 803 (81 %) past, 77 (8%) present, and 1 13 (I I%) future deployers to 

OEF, GTMO or OIF. These interviewees included 705 (71%) males and 288 (29%) 

females; 522 (52.7%) officers, 3 (0.3%) warrant officers, and 468 (47%) enlisted 

personnel. 

Questionnaires were completed by 166 students at the AMEDDC&S, encompassing 20 

91G (Patient Administration Specialist), 74 91 W (Health Care Specialist), 17 91 WM6 

(Health Care SpecialistlLicensed Practical Nurse), 15 91X (Mental Health Specialist), 

and 40 Officer Basic Course (OBC) students. 

A total of 12 PPP questionnaires were completed at Ft. Benning (1 MOB, 1 CRC), Ft. 

Bliss (I MOB, 1 CRC), Ft. Carson (I MOB), Ft. Dix (I MOB), Ft. Drum (I MOB), Ft. 

Hood (I MOB), Ft. Lewis (I MOB), Ft. Polk (I MOB), Ft. Riley (I MOB), and Ft. Sill (I 

MOB). lnterviews were conducted at the JRTC (Ft. Polk) and NTC (Ft. Irwin). 
Interviews were conducted with 11 past (6) and present (5) Behavioral Science 

Consultation Team (BSCT) members assigned to GTMO (7) and OIF (4). 

Policy and Guidance 

Theater-Level Policy and Guidance. In reviewing policy and guidance, including 

Operation Orders (OPORDERs), Fragmentary Orders (FRAGOs), and Standing 

Operating Procedures (SOPS), OEF theater-specific detainee medical policies were 

found dating back to 2004; 47% of past and 60% of present OEF interviewees were 

aware of the policies. GTMO had well-defined detainee medical policies that have been 

in place since 2003; 100% of the interviewed personnel were aware of the policies. For 

OIF, there was no evidence of specific theater-level policies for detainee medical 

operations until 2004. Only 56% of past OIF interviewees were aware of policies in 

theater, whereas 88% of current OIF interviewees were aware of policies in theater. 

This improvement is attributed to the superlative efforts of TF134, combined with the 

introduction of one field hospital for level Ill+ detainee health care management across 

the theater. 

Standard of Care. In the early stage of OIF, there was confusion among some medical 

personnel, both leaders and subordinates, regarding the required standard of care for 

detainees. Medical personnel were unsure if the standard of care for detainees was the 

same as that for U.S./Coalition Forces in theater, or if it was the standard of care 

available in the Iraqi health care system. This confusion may be explained by the use of 

different classifications for detained personnel (Enemy Prisoner of War (EPW), 

detainees, Retained Personnel (RP), Civilian Internees (CI)) that, under Department of 

Defense (DoD) and Department of the Army (DA) guidance, receive different levels 

care. Theater-level guidance was not provided in a timely manner to early-deploying 

medical units or personnel, and in the absence of guidance many units developed their 

own policies. As the OIF theater matured and roles and responsibilities were clarified, 

theater-level policy was developed and promulgated, resolving the early confusion. 

Recommendations. Although not required by law, DA guidance (DoD level is 

preferable) should standardize detainee medical operations for all theaters, should 

clearly establish that all detained individuals are treated to the same care standards as 

U.S. patients in the theater of operation, and require that all medical personnel are 

trained on this policy and evaluated for competency. 

Medical Records 

Medical Records Training. Medical records management was a primary area of focus 

for this assessment. When asking past/present/future personnel from OEF, GTMO, and 

OIF about their training in detainee medical records management, 4% of AC and 6% of 

RC interviewees received Military Occupational Specialty (MOS) or other school 

training. When asked about unit training at home station, 6% of AC and 4% of RC 

interviewees reported receiving training. During mobilization, 5% of AC and 8% of RC 

interviewees reported receiving training about detainee medical records. For 
pastlpresent personnel from OEF, GTMO, and OIF, 27% of AC and 35% of RC 

interviewees reported receiving training in theater. 

Medical Records Generation. There was wide variability in medical records generation 

at level I and II facilities. In some cases, no records were generated. In others, 

detainee care was documented in a log book for statistical purposes and unit reports. In 

other cases, care was documented on Field Medical Cards (FMCs) (Department of 

Defense Form 1380 (DD1380)) only. Some of the units with log books or FMCs created 

Standard Form 600 (SF600) (Chronological Record of Medical Care) for detainee 

patients requiring complex treatment, with chronic medical conditions, andlor for those 

being evacuated to higher levels of care. Some units used overprinted SF600 to 

document screenings, and others used completed SF88 (Report of Medical 

Examination) and SF93 (Report of Medical History). Level Ill facilities consistently 

generated detainee medical records in the same manner as records for U.S. and 

Coalition Forces. 

Access to and Security of Detainee Medical Records at Detention Medical Facilities. 

The Team was asked to address access to, and security of, detainee medical records at 

detention medical facilities. This was accomplished with several specific interview 

questions as well as direct observations and questions during site visits to the facilities 

at OEF, GTMO, and OIF. Individual responses to the pertinent questions were 

generally very consistent within each location, as well as across all locations. In 

general, the medical records for detainees were managed the same as records for the 

AC. The security of records and confidentiality of medical information tended to be 

better at detention facilities that were co-located with medical facilities. Security and 

confidentiality also generally improved as an individual theater matured. When asked 

about which "other" personnel could have access to detainee medical records besides 

the treating medical personnel, the vast majority of answers were: Patient 

Administration (PAD), Criminal Investigation Division (CID), the International Committee 

of the Red Cross (ICRC), and medical chain of command. Very few individuals 

responded that military police (MP) or other detention facility personnel could have 

access to medical records. 

Medical Screening, Medical Care: and Medical Documentation Associated with 

Interrogation. There are inconsistencies in the guidance for pre- and post-interrogation 

screening. Medical care, including screenings, at or near the time of interrogation, was 

neither consistently documented nor consistently included in detainee medical records. 

Some medical personnel were unclear whether interrogations could be continued if a 

detainee required medical care during the interrogation. Medical personnel at some 

locations felt empowered to halt interrogations for either medical or safety reasons. 

Storage of Originals and Copies of Medical Records. The team found that level I and II 

facilities stored original medical records at detention facilities, detention medical 

facilities, and medical unit treatment areas. In some cases the records were maintained 

with interrogation records maintained by MI or MP personnel. At level Ill facilities, the 

originals were maintained by PAD. The availability of copy machines was variable; 
therefore, when detainees were transferred to other detention facilities or medical 

facilities, either the original or a copy of the medical record was sent. 

Disposition of Medical Records. The original detainee medical records and original U.S. 

Forces medical records at level Ill facilities are sent to Patient Administration Systems 

and Biostatistics Activity (PASBA). Within and among all interviewed units providing 

level I and II medical care, there was extreme variability in the method of 

documentation, the circumstances influencing the creation of documentation, and the 

maintenance and final disposition of detainee medical records. 

Recommendations. DA guidance (DoD level is preferable) should require that detainee 

medical records at facilities delivering level Ill and higher care be generated in the same 

manner as records of U.S. patients in theater. Guidance should address the appropriate 

location and duration of maintenance as well as the final disposition of detainee medical 

records at facilities that deliver level Ill or higher care. Most importantly, guidance is 

needed to define the appropriate generation, maintenance, storage, and final disposition 

of detainee medical records at units that deliver level I and II care. 

Reporting of Detainee Abuse 

Abuse Reporting Training. The Team found that 16% of AC and 15% of RC 

interviewees (past/present/future OEFIGTMOIOIF combined) received MOS or other 

school training about reporting possible detainee abuse. When asked about training at 

home station on this topic, 21 % of AC and 14% of RC interviewees reported receiving 

training. During mobilization, 25% of AC and 26% of RC interviewees reported 

receiving training. For the pastlpresent OEFIGTMOIOIF deployers, 40% of AC and 

26% RC interviewees reported receiving this training in theater. 

Abuse Reporting Policies. Unit policies, SOPS and Tactics, Techniques, and 

Procedures (TTPs) were most often either absent or not properly disseminated to 

deployed medical personnel. The Team found no DoD, Army, or theater policies 

requiring that actual or suspected abuse be documented in a detainee's medical 

records; however, theater-level guidance specifically requiring medical personnel to 

report detainee abuse was implemented just within the past year. The Team found that 

37.0% (295 of 798) of formerly deployed OEFlGTMOlOlF interviewees were aware of a 

unit requirement to report suspected detainee abuse; 94.2% (278 of 295) of these 

interviewees reported their unit followed the policies; 85.5% (65 of 76) of presently 

deployed OEFIGTMOIOIF interviewees were aware of such policies; and 98.5% (64 of 

65) of these interviewees reported their unit followed the policies. Medical personnel 

with knowledge of existing unit policieslSOPs1TTPs overwhelmingly complied with such 

guidance (94%) and, over time, awareness of unit level policies requiring reports of 

detainee abuse has steadily increased. 

Observing and Reporting Suspected Detainee Abuse. The personnel interviewed 

during this assessment were vigilant in reporting actual or suspected detainee abuse to 

their medical supervisor, chain of command, or CID. Only 5% of previously deployed 
interviewees directly observed suspected abuse and only 5% had a detainee report 

abuse to them. Previously deployed interviewees reported the suspected abuse 91% of 

the time when the suspected abuse was alleged by a detainee and 80% if they directly 

observed suspected detainee abuse. For those interviewees presently deployed, 25% 

had a detainee report alleged abuse and 3% directly observed suspected abuse. All 

presently deployed interviewees reported the alleged or suspected abuse. Only 2 

medical personnel failed to properly report actual or suspected detainee abuse that had 

not previously been conveyed to an appropriate authority. The Team referred these 

cases to the CID. 

Recommendations. 

Medical. At all levels of professional training, medical personnel should receive 

instruction on the requirement to detect, document and report actual or suspected 

detainee abuse. This training should include the definition and signs of suspected 

detainee abuse. Scenario-based training on detecting detainee abuse should be 

developed and fielded at non-Army Medical Department (AMEDD) training sites such as 

JRTC, NTC, PPP, CRC, etc. All deploying medical personnel should receive this 

training prior to arrival in theater. 

DoD-Wide. It is important to have clearly written standardized policies for detecting, 

documenting and reporting actual or suspected detainee abuse at all levels of 

command. Medical planners at all levels should ensure clearly written standardized 

guidance is provided to all medical personnel. This guidance should list possible 

indicators of abuse and contain concise instruction documentation and procedure for 

reporting actual or suspected abuse. 

Other Issues 

This assessment addressed several other issues the Team deemed relevant to 

detainee medical operations that were not specifically directed by the appointing 

memorandum. The topics include: (1) overview from site visits to Afghanistan, Cuba 

and Iraq; (2) OIF theater preparation for detainee care; (3) medical screening and sick 

call at the division internment facilities (DIFs) and prisons; (4) restraints and security; 

(5) medical personnel interactions with interrogators; (6) medical personnel 

photographing detainees; (7) the use of behavioral science consultation teams(BSCT) 

in the interrogation process; (8) stress on medical personnel providing detainee medical 

care; and (9) interviewee training requests. 

Overview of Site Visits to Afghanistan, Cuba and Iraq. The overall quality of outpatient 

and inpatient detainee medical care is extremely high. Detainees are treated with 

dignity and respect. Detainee rights and patient rights are clearly posted. Medical 

records are very complete and contain master problem lists. Daily sick call is well 

organized. Medical personnel know procedures for reporting abuse and follow those 

procedures. All facilities are staffed with extremely dedicated personnel who take their 

responsibilities very seriously. 
OIF Theater Preparation for Detainee Care. In planning for detainee medical 

operations, there were limited assets allocated to provide support for detainee1EPW 

medical care. The plan did not encompass medical assets to provide chronic care, 

definitive care, or rehabilitative care. There was a requirement to deliver medical care 

to detainees in theater; however, level I, II, and Ill medical assets were not resourced to 

care for the special needs presented by this population. Recommend the AMEDD 

establish an experienced subject matter expert (SME) team to comprehensively define 

the personnel, equipment, and supply needs to support detainee medical operations, 

and develop a method to ensure a flexible delivery system for these special resources. 

Medical Screening and Sick Call at the Division Internment Facilities (DIF) and Prisons. 

The Team found that detainees have excellent access to daily sick call, outpatient, and 

inpatient medical care at the DlFs and Prisons. The vast majority of interviewees 

reported that initial screening medical examinations were performed during inprocessing to a DIF or prison. Recommend DA guidance (DoD level is preferable) 

require initial medical screening examinations shortly after arriving at the detention 

facility. 

RestraintslSecurity. The use of physical restraints for detainees varied widely within 

and among all interviewed units. The Team found no evidence that medical personnel 

used medications to restrain detainees. lnterviewees reported medical personnel were 

tasked to perform a variety of detainee security roles. Medical documentation of 

restraint was neither uniform nor consistent. Some medical units used restraints on all 

detainees for security reasons, some used them only when detainees were violent or 

disruptive, and others (specifically level Ill facilities) used them only for medical 

indications such as attempts to dislodge medical devices, or for risk of falling. 

lnterviewees expressed concern over the tasking of medical personnel for detainee 

security purposes. This concern is based on the ethical conflict of both caring for and 

guarding detainees. Additionally, as medical personnel were tasked to provide security 

support, it impacted on the ability of the medical unit to provide care to all patients, 

including U.S. Soldiers. Recommend DA (DoD level is preferable) standardize the use 

of restraints for detainees in units delivering medical care. The guidance should contain 

clear rules for security-based restraint versus medically-based restraints. Medical 

personnel should not be encumbered with duties related to security of detainees. 

Medical Personnel Interactions with Interrogators. The Team found that medical 

personnel participation in interrogations was exceedingly rare and was reported only 

five times, and occurred only in OIF at units providing level I or II care. The evaluation 

or treatment of detainee patients was rarely delayed for intelligence gathering purposes. 

Medical personnel were rarely requested to be present during interrogations. Many 

interviewees reported the existence of policies that addressed the interaction between 

medical personnel and interrogators; however, dissemination and awareness of these 

policies were inconsistent. As the OEF and OIF theaters matured, dissemination and 

awareness of these policies improved for level Ill facilities. DA guidance (DoD level is 

preferable) should prohibit all medical personnel from active participation in 
interrogations. This includes medical personnel with specialized language skills serving 

as translators. Empower medical personnel to halt interrogations when a necessary 

examination or treatment is required. 

Medical Personnel Photographing Detainees. There are inconsistencies among Army 

Regulations, individual unit guidance, and usual medical practices regarding 

photographing detainees. Many medical personnel photographed detainees for a 

variety of reasons including medical documentation, future teaching material, supporting 

criminal investigation, and to provide a means for family members to identify a detainee. 

While AR 190-8, paragraph 1-5d, strictly prohibits photographing enemy prisoners of 

war, retained persons, and civilian internees "for other than internal internment facility 

administration or intelligencelcounterintelligence purposes," chapter 34 of the 2004 

edition of the text "Emergency War Surgery" advocates units having a digital or other 

high quality camera for use in medical documentation of EPW injuries. This text also 

advocates the inclusion of faces in these pictures for accurate, efficient, and complete 

documentation of patient injuries and surgical interventions. Additionally, AR 40-66, 

paragraph 2-8b (which is not specific to detainees), permits photographs but requires 

consent be obtained prior to releasing photographs "of a person or of any exterior 

portion of his or her body" for the purpose of research. DA guidance (DoD level is 

preferable) should authorize photographing detainee patients for the exclusive purpose 

of including these photos in medical records. Informed consent should not be required 

to use photographs in this manner (consistent with AR 40-66). Additionally, 

photographs of detainees taken by medical personnel for other reasons, including future 

educational material, research, or unit logs, should require a detainee's informed 

consent. 

Behavioral Science Consultation Teams (BSCT). BSCTs consisted of physicians1 

psychiatrists and psychologists who directly support detainee interrogation activities. 

Physicians and psychologists were initially assigned to this duty in 2002 at GTMO and 

in December 2003 for OIF. Since January 2004 these positions have been staffed by 

psychologists. This issue has been raised in previous assessments and investigations. 

There is no doctrine or policy that defines the role of behavioral science personnel in 

support of interrogation activities. The most complete guidance found by the Team 

were SOPS that describe the role and responsibilities of personnel serving in BSCT 

positions. In the purest sense, the mission of the BSCT is to provide forensic 

psychological expertise and consultation to assist the command in conducting safe, 

legal, ethical, and effective interrogation and detainee operations. DoD should develop 

well-defined doctrine and policy for the use of BSCT personnel. A training program for 

BSCT personnel should be implemented to address the specific duties. The Team 

recommends that more senior psychologists should serve in this type of position. There 

is no requirement or need for physicianslpsychiatrists to function in this capacity. 

Stress on Medical Personnel Providing Detainee Medical Care. Medical personnel 

were not specifically asked to describe their personal deployment experiences; 

however, during numerous interviews memories of personal experiences re-surfaced 

Many of these interviewees noted this was the first time they had the opportunity to 
share personal experiences. The issues raised by medical personnel included the 

ethical dilemma of providing care to insurgents that killed or injured U.S. Soldiers, 

providing care to Soldiers and Iraqis with limited medical resources, the quantity and 

severity of the injuries observed, and the stress of a warfare environment. Recommend 

the US. Army Medical Command (MEDCOM) establish an experienced SME team 

comprised of a psychiatrist, a psychologist, chaplain, and clinical representation from all 

levels of care, to comprehensively define the training requirements for medical 

personnel in their pre-deployment preparation. Other initiatives include revising combat 

stress control doctrine to effectively deliver support to medical personnel in theater, 

develop an effective system to regularly monitor post deployment stress, and refine 

leadership competencies to assess, monitor and identify coping strategies of medical 

personnel in a warfare environment. 

Interviewee Training Requests. The Team asked interviewees the following question: 

"If you were responsible for the training of medical personnel prior to deployment, what 

aspects of training would you focus on with regard to detainee care?" Many 

interviewees noted that current training in this area was not sufficient. The most 

commonly recommended topics were: cultural awareness training (including religious 

differences, local customs, accepted societal behaviors, diet, etc.); basic medical and 

conversational language training for the respective area of operation, with emphasis on 

triaging and treating detainee patients and U.S.ICoalition patients in the same manner; 

and medical Rules of Care. Other key training needs identified by the interviewees 

were stress management for medical personnel; retraining for sub-specialists utilized in 

other roles (e.g., primary care, emergency room, or general surgery); how to handle 

interactions with other government agencies (OGAs), MI personnel, and interpreters; 

field sanitation issues; preparation for long-term care of detainees; treatment of blast 

and gunshot injuries; and interest in having more mass casualty (MASCAL) exercises. 

Conclusion 

The Team was very impressed with current detainee medical operations in OEF, 

GTMO, and OIF. In the early phases there were definite shortcomings; however, in the 

ongoing maturing process, policies are being established, training conducted, and 

resources provided to ensure appropriate standardized detainee medical operations. 

Indeed, a number of interviewees discussed shortcomings at their arrival, but reported 

significant improvements during their tour. There are still opportunities for improvement 

and the Team has provided a comprehensive list of recommendations to assist the 

process. We have been honored to conduct this assessment; the experience has 

reinforced our pride as members of the AMEDD. 
Chapter 2 

Background 

2-1. Synopsis 

a. With the current hostilities in Afghanistan (OEF) and Iraq (OIF), and the 

confinement by U.S. military personnel of detainees in Afghanistan (GTMO) and Iraq, 

concerns regarding the appropriate treatment of detainees, including during 

interrogation and access to medical care, have arisen. Increased concern arose with 

revelations of detainee abuse in the Abu Ghraib Detention Facility in Iraq. Additionally, 

reports in the press have alleged wrongdoing by military medical personnel. 

b. A series of investigations have alleged wrongdoings and have recommended 

reforms, including actions of Army medical personnel. Some of these reports looked at 

medical issues; however, to date, there has not been a medical specific assessment of 

detainee operations in OEF, GTMO or OIF. 

c. The Army Surgeon General (TSG), LTG Kevin C. Kiley, reviewed the FayIJones 

report (Cit. 25) with the Army's senior leadership, including recommendations that 

further inquiry was necessary to determine (i) if detainee medical records were properly 

maintained; and (ii) if medical personnel were aware of detainee abuse and failed to 

report the abuse. 

d. On 12 November 2004, LTG Kiley directed MG Lester Martinez-Lopez, 

Commander of the U.S. Army Medical Research and Materiel Command, to lead a 

Functional Assessment Team (the Team) to determine whether detainee medical 

records were properly maintained; whether medical personnel were aware of detainee 

abuse and failed to report abuse; and to determine whether medical personnel received 

and/or are currently receiving appropriate training so that they are fully prepared to 

perform the mission of caring for detainees. 

2-2. Chronology of Important Events 

11 Nov 01 First detainees secured at Mazar-e-Sharrif 

Dec 01 Bagram Hold~ng Area (BHA) and Kandahar Hold~ng Area (KHA) open 
Detent~on Fac~lrt~es" (Schlesmger Report) 

2-3. Previous Reports - Summary of Findings and Recommendations Regarding 

Detainee Medical Care 

a. Ryder Report (Cit. 39). The Ryder Report contains several observations regarding 

detainee medical care, health management and medical care. 

(1) No clear delineation of the responsibilities of health care existed for the various 

detainee categories. This resulted in confusion regarding the responsibilities between 

the US. military and CPA health care systems. MG Ryder stated a clear need for 

published guidance regarding detainee categorization and health care directives. 

(2) The expansion of mission responsibilities, to include serving as the Iraqi 

correctional medical system until it is fully operational, challenged the health care 

delivery system. 
(3) The rapid turnover of MP Bde Surgeons, on a 90-day rotation, creates 

significant correctional health care management concerns and inefficiencies. 

Recommended a one-year rotation for Bde Surgeons who are versant in preventive 

medicine andlor correctional medical operations for continuity and mission oversight. 

(4) Mentally ill detainees were receiving no treatment. Mental illness was a 

grossly neglected area for the health care of Iraqi detainees. Mental health services 

must be incorporated into the correctional health care model. 

b. Taguba Report (Cit. 44). The Taguba report contains minimal comments regarding 

medical care and medical assets at Abu Ghraib. Two medics provided witness 

statements. Additionally, testimony from non-medical personnel and detainees included 

both positive and negative comments concerning medical personnel at Abu Ghraib. 

c. DAlG Report (Cit. 19). This inspection was a comprehensive review of how the 

Army conducts detainee operations in Afghanistan and Iraq. Medical issues related to 

detainee care were included in this functional analysis. 

(1) Holding detainees for longer timeframes at all locations resulted in increased 

requirements in facility infrastructure, medical care, preventive medicine, trained 

personnel, logistics, and security. Organic unit personnel at these locations did not 

have the required institutional training and were therefore unaware of, or unable to fully 

comply with, Army policies in areas such as detainee processing, confinement 

operations, security, preventive medicine, and interrogation. 

(2) The DAlG Team inspected four InternmentIResettlement facilities and 12 

forward and central collection points. No units fully complied with the Geneva 

Conventions requirements for medical treatment of detainees, or with the required 

sanitary conditions for detainee facilities. Not all medical personnel were aware of 

detainee medical treatment requirements. They also lacked the proper equipment to 

treat a detainee population. Medical personnel reported no specific training in detainee 

operations. There was a widespread lack of preventive medicine resources. 

d. FaylJones Report (Cit. 25). This report did not focus on issues of medical care. 

The report contains references to, and statements by, medical personnel regarding 

suspicion of, knowledge of, and reporting of detainee abuse. The report also concludes 

medically related joint doctrine and policy was not always followed. 

(1) Specifically, joint doctrine and policy defines a requirement for medical 

screening of all detainees. This requirement was not being met at Abu Ghraib. 

Additionally, there was an absence of medical documentation for some detainees, and a 

general absence of a centralized management system for medical evaluations. The 

report also concludes that medical personnel are included in the 54 personnel found to 

have some degree of responsibility or complicity in the abuse that occurred at Abu 

Ghraib. 
(2) This report recommends improved training to all personnel in Geneva 

Conventions, detainee operations, and the responsibilities of reporting detainee abuse. 

The report recommends Training and Doctrine Command (TRADOC) address medical 

record keeping and information sharing requirements. 

e. Church Report (Cit. 15). Specific medically related findings include: 

(1) Medical personnel understood their responsibility to provide humane medical 

care to detainees in accordance with US. military medical doctrine and the Geneva 

Conventions. 

(2) There was inconsistent field level implementation of medical documentation, 

medical record handling, and medical treatment (for example, medical screenings). 

(3) The report described the role of behavioral science personnel who assisted 

interrogation personnel to include observing interrogation, assessing detainee behavior 

and motivations, reviewing interrogation techniques, and offering advice to 

interrogators. Behavioral science personnel were not involved in detainee medical care, 

nor did they have access to detainee medical records. This report recommended a DoD 

level policy review to ensure behavioral science teams performed with proper 

safeguards. The report also recommended the status of medical personnel who do not 

participate in patient care be clarified. 

(4) DoD level policy review was necessary to define intelligence personnel access 

to detainee medical information. There was a substantial variation in access to medical 

information in different locations. However, no misuse of this information was identified. 

(5) Admiral Church concluded there was no way to know if medical personnel 

reported abuse as necessary. Medical personnel stated they reported abuses when it 

was suspected. The report states that it appeared that medical personnel may have 

attempted to misrepresent the circumstances of three separate detainee deaths, 

possibly in an effort to disguise detainee abuse. 

f. Schlesinger Report (Cit. 40). This report contains only one specific medically 

related recommendation (which originated with the FayIJones). At least three of the 14 

recommendations are applicable to all medical leadership and personnel engaged in 

detention operations. The three recommendations are: 

(1) The nation needs more specialists for detentionlinterrogation operations, 

including linguists, interrogators, human intelligence (HUMINT), counter-intelligence, 

corrections police and behavioral scientists. 

(2) All personnel engaged in detention operations from the point of capture to final 

disposition, should participate in a professional ethics program that would serve as the 

moral compass for guidance in situations with conflicting moral obligations. 
(3) Several recommendations from the Fay investigation cited the failure of 

medical personnel to report detainee abuse, shortfalls in training and force structure for 

field sanitation, preventive medicine and medical treatment requirements for detainees. 

g. The Team reviewed two reports that are presently classified - the Miller Report 

and the Jacoby Report (Cit. 29). 
Chapter 3 

Methodology 

3-1. Team Members. In a memo dated 12 November 2004, TSG, LTG Kevin C. Kiley, 

directed the Team to specifically assess issues related to detainee medical care in the 

OEF, GTMO, and OIF (Exhibit A, Annex 1). MG Lester Martinez-Lopez, Commanding 

General, U.S. Army Medical Research and Materiel Command and Fort Detrick, Fort 

Detrick, MD, led the multi-disciplinary team, which included (see Exhibit B for Team 

biosketches): 

b. co~~b)n-2 MC, Staff Internist and Intensivist, Fb)(6)~2 

lnternal Medicine Cdnsultant to TSG~(~)-~ 

C, COL b)W2 IAN, Deputy Commander for Health services,- 

Fb)(6)-2 

I JA, Staff Judge ~dvocate,P"'~ 

b)(W 

program ,lb)(6)~2 IMC, Proqram Director, Internal Medicine Residency 

f, MSG b)(6)-2 191W, Soldier Medic Training Site, Noncommissioned Officer in 

Charae (NCOIC~.P)(~)-~ 

3-2. Assessment Questions. The appointment memo specifically directed the Team 

to assess the following with respect to AC and RC Army medical personnel providing 

medical support and care to detainees in OEF, GTMO and OIF: -

a. What units provided medical care to detainees in OEF and OIF and what was the 

period of service for each unit? 

b. At what location did each unit provide medical care (e.g., Medical Treatment 

Facility (MTF): detainee facility, and interrogation facility)? 

c. What Military Occupational Specialty (MOS) and Officer Basic Training (OBC) 

training or other school training did the medical personnel serving in these units receive 

regarding the generation, storage and collection of detainee medical records and 

regarding the medical reporting of detainee abuse? 

d. Was there any policy guidance, Operation Order (OPORDER), standard operating 

procedure (SOP). or other authority establishing criteria for providing detainee medical 

support andlor care in theater of operation? 
e. What unit training did the active component (AC) receive prior to deployment 

regarding the generation, storage and collection of detainee medical records and the 

medical reporting of detainee abuse? 

f. What unit training did the RC receive at home station, power projection platforms 

(PPP) and in-theater regarding the generation, storage and collection of detainee 

medical records and the medical reporting of detainee abuse? 

g. Identify OEF and OIF detention medical facilities. 

h. With respect to the detention medical facilities identified in subparagraph g, 

determine if the facility generated, stored and collected detainee medical records to 

include records documenting medical support to any detainee being prepared for 

interrogation, being interrogated, or needing medical treatment as a result of, or 

immediately after, interrogation. 

i. With respect to those detention facilities that kept medical records, did medical 

personnel properly generate, store and collect appropriate medical records of 

detainees? 

j. With respect to those detention facilities that kept detainee medical records, 

identify the location where the original and any copies of the records are maintained. 

k. Were any medical personnel aware of, or treat injuries related to, actual or 

suspected detainee abuse? 

I. Did any medical personnel aware of, or who treated actual or suspected, detainee 

abuse properly document the abuse? 

m. To whom did any medical personnel aware of, or who treated, detainee abuse 

report such abuse? 

n. Were there any theater or unit policies or established SOP'slTactics, Techniques 

and Procedures (TTP) that specifically required medical personnel to report detainee 

abuse? 

3-3. Assessment Focus. From the assigned Assessment Questions, the Team 

determined four areas of Assessment Focus: 

a. Training. 

b. Detainee medical policies and procedures. 

c. Medical records management. 
d. Incidence of and reporting of detainee abuse by medical personnel. 

3-4. Methods 

a. In formulating the assessment approach, the Team reviewed previous 

assessments related to detainee operations and investigations of detainee abuse as 

well as theater level and unit policies, Army regulations (AR) and field manuals (FM) 

outlining the precepts of detainee operations (included in Chapter 27, References). The 

Team reviewed numerous classified documents. The report purposefully cites only 

unclassified portions of classified documents. The use of these unclassified portions 

was coordinated with the Medical Research and Materiel Command Operations 

Division. 

b. Based on the review, the Team identified an additional area of focus: the role of 

medical personnel in the detainee interrogation process. 

c. A questionnaire-based measurement tool was determined to be an efficient and 

effective methodology for obtaining the desired information. Questionnaires with 

interview questions were developed based on the fourteen assessment questions and 

four assessment focus areas. 

d. A signed Privacy Act Statement (Exhibit C, Annex 3) and Sworn Statement on 

DA Form 2823 were obtained from interviewees, as explained below. 

e. The assessment methodology was designed with a three-pronged approach. 

(1) Training Questionnaires 

(a) Student Questionnaire. Used to assess detainee medical operations training 

at the AMEDDC&S. Not a Sworn Statement, not individual interviews. (Exhibit C, 

Annex 8) 

(b) PPP1 CRC Questionnaire. Used to assess detainee medical training 

conducted at the major PPP and CRC training sites. Not a Sworn Statement, individual 

interviews. (Exhibit C, Annex 6) 

(c) JRTC and NTC Questionnaire. Used to conduct interviews at the JRTC and 

the NTC. Not a Sworn Statement, individual interviews. (Exhibit C, Annex 9) 

(2) Behavioral Science Consultation Team Questionnaire. Used to interview 

personnel serving on BSCTs at GTMO and OIF (Abu Ghraib). Sworn Statement with 

individual interviews. (Exhibit C, Annex 7) 

(3) PastlPresent Deploying Medical Personnel Questionnaire and Future 

Deploying Medical Personnel Questionnaire. Used to interview medical personnel 

supporting detainee operations in maneuver, combat support, and combat service 
support units preparing to deploy (future), those previously deployed (past) and 

personnel currently deployed (present) to obtain a wide-ranging perspective on the 

myriad of issues related to detainee medical operations, including a sampling of echelon 

level I, II and Ill care providers. After developing a set of core questions, customized 

questionnaires were developed for different duty positions working at the three levels of 

care in the past and present or future (PastIPresent and Future Questionnaires). A 

questionnaire with additional questions was also developed to interview headquarters 

commanders. Sworn Statement with individual interviews. (Exhibit C, Annex 4 & 5) 

f. In preparation for conducting the initial surveys and interviews, detainee medical 

records and detainee autopsy reports were reviewed. Information gleaned from this 

review provided a list of potential medical personnel for the Team to interview. The 

Team identified ACIRC units with past, present or future deployments to OEF, GTMO 

and OIF. The Team did not interview special operational units or special operations 

personnel. The Team then scheduled interviews and traveled to the units' locations to 

interview personnel. 

3-5. Interviews and Units 

a. The Team interviewed medical personnel in maneuver, combat support, and 

combat service support units in 22 states and 5 countries. The interviewees were in a 

past, present or future deployment status for OEF, GTMO, or OIF and included AC and 

RC personnel. For the current interviews, the Team visited the detention medical 

facilities in Afghanistan (Baghram) and Cuba (Guantanamo Bay). In Iraq, the Team met 

with the Commander, TF 134, and interviewed medical personnel supporting detainee 

operations at Abu Ghraib, Camp Danger, Camp Liberty and Camp Bucca. In Kuwait, 

the Team met with the CFLCC Deputy Commander and Chief of Staff, as well as the 

CFLCC Surgeon, to gain a perspective on the planning factors for detainee medical 

operations. For the past and future interviews, the Team traveled to units in 22 states 

and Germany. A leadership perspective on the issue of detainee medical operations 

was gained through interviews with medical personnel from command and control (C2) 

elements at corps, theater, and level I, II and Ill medical units. For training interviews, 

the Team visited faculty and students of training programs at the AMEDDC&S and the 

MI School, and trainers at NTC, JRTC, the two CRCs, and 12 PPPs. Additionally, 

lesson plans and other training materials were reviewed at these training sites. 

b. A total of 1,182 questionnaires were completed in the following categories: 

(1) Student Questionnaires. A total of 166 student questionnaires were completed 

at the AMEDDC&S, encompassing 20 91 G (Patient Administration Specialist), 74 91 W 

(Health Care Specialist), 17 91 WM6 (Licensed Practical Nurse), 15 91X (Mental Health 

Specialist), and 40 OBC students. The findings, discussion, and recommendations are 

in Chapter 6. 

(2) PPP Questionnaires. A total of 12 PPP Questionnaires were completed at Ft. 

Benning (I Mobilization, 1 CRC), Ft. Bliss (I MOB, 1 CRC), Ft. Carson (I MOB), Ft. Dix 
(1 MOB), Ft. Drum (I MOB), Ft. Hood (I MOB), Ft. Lewis (I MOB), Ft. Polk (I MOB), 

Ft. Riley (I MOB), and Ft. Sill (1 MOB). The findings, discussion, and 

recommendations are in Chapters 8, 9 and 18. 

(3) JRTC and NTC: lnterviews were conducted at the JRTC (Ft. Polk) and NTC 

(Ft. Irwin). The findings, discussion, and recommendations are in Chapter 18. 

(4) BSCT Questionnaires: lnterviews were conducted with 11 past (6) and 

present (5) BSCT members assigned to GTMO (7) and OIF (4). The findings, 

discussion, and recommendations are in Chapter 18. 

(5) PastlPresent and Future Questionnaires. The team completed 993 

interviews(80%AC/8%USAR/12%NG) with 803 (81 %) interviews from units which 

previously served in OEF, GTMO or OIF (past), 77 (8%) currently serving in OEF, 

GTMO or OIF (present), and 113 (1 1%) preparing to mobilize to OEF, GTMO or OIF 

(future). The interviewees included 705 (71 %) males and 288 (29%) females, including 

522 (52.7%) officers, 3 (0.3%) warrant officers, and 468 (47%) enlisted personnel, with 

a mean age of 34.77 years. The findings, discussion, and recommendations are in 

following chapters of the report. 

c. Units. A total of 180 units were sampled, as listed in Tables 3-1 through 3-6. 
Table 3-1. OEF Medical Units 

Table 3-2. OEF Non-divisional Non-medical Units 

Table 3-3. OEF Divisional Non-medical Units 
Table 3-4. OIF Medical Units 

bW2 

Table 3-5. OIF Non-divisional Non-medical Units 
Table 3-6.OIF Divisional Non-medical Units 
Chapter 4. 

Question a. What units provided medical care to detainees in OEF and OIF and 

what was the period of service for each unit? 

4-1. Listed below are units who provided detainee care in OEF and OIF. The Team 

defined "providing detainee care" as any unit assigned medical resources that, at any 

time, provided care to at least one detainee. Also listed are the units of medical 

personnel who, at any time while in either theater, individually provided care to at least 

one detainee. 

4-2. The list is not all-inclusive. The ability to capture 100% of the units involved in 

detainee care was a challenge. It was difficult to identify all the "one for one" medical 

personnel replacements and attachments. Another factor was the mission-required 

integration of non war-traced units. This included AClRC medical units that were not 

previously configured to serve as a cohesive unit. Dates of service given were obtained 

from interviews and may not represent the exact period of service for the entire unit. 

The Team is confident that the below list is accurate and represents the scope and 

breadth of units that provided detainee care. 

a. Operation Enduring Freedom 

Non-Medical Units Arrival Departure - .? 
b. Operation Iraqi Freedom 





Chapter 5. 

Question b. At what location did each unit provide medical care (e.g., MTF, 

detainee facility, and interrogation facility)? 

The answers to this question are found in Chapter 10 (Question g). 
Chapter 6 

Question c. What MOS and OBC training or other school training did the medical 

personnel serving in these units receive regarding the generation, storage and 

collection of detainee medical records and regarding the medical reporting of 

detainee abuse? 

Section I 

Summary of Findings 

6-1. Summary of Findings and Recommendations 

a. Overall, less than 3% of medical personnel surveyed from the AC and 7% from the 

RC (past and present) medical personnel reported receiving training on detainee 

medical records. Refer to Table 6-4 to view AMEDDC&S student responses. A SME 

team comprised of individuals with exceptional knowledge of the generation, storage 

and collection (disposition) of detainee medical records should standardize training 

requirements and develop competency-based training for levels I-Ill in all theaters. 

b. Overall, less than 15% of medical personnel from the AC, USAR, and NG (past 

and present) reported receiving MOS or other school training about reporting possible 

detainee abuse. Refer to Table 6-1 to view responses for OEF, GTMO and OIF. 

MEDCOM should appoint a SME team under the direction of the AMEDDC&S to 

develop the tasks and framework to build a comprehensive training program to train 

medical personnel on detention health care including medical reporting of detainee 

abuse with follow-up assessment of competency to measure effectiveness of training. 

Section II 

Training Received Regarding Generation, Storage and Collection of Detainee 

Medical Records 

6-2. Findings 

a. Less than 3% of medical personnel surveyed from the AC and 7% of the RC (past 

and present) reported receiving training on detainee medical records. Students 

surveyed in the OBC and four MOS -specific courses do receive training on medical 

records; however, there is minimal to no evidence that students receive training specific 

to the generation, storage and collection, and disposition of detainee medical records. 

See Table 6-4. 

b. The majority (97%) of medical personnel surveyed from the AC and 93% from the 

RC that have served or are serving in OEF, GTMO, and OIF report they did not receive 

any school training on detainee medical records. See Table 6-1. 

c. Of the nine PAD officers (MOS 70E) and ten PAD specialists surveyed, 30% 

reported receiving school training specific to detainee medical records in their courses. 
d. The 70E Program Director offers a "Just-in-Time Deployment Training" course 

for deploying PAD officers (Cit. 4). The course curriculum mirrors the guidance in the 

MEDCOM memo entitled "Deployment Medical Documentation GuidanceIReporting 

Requirements." 

e. The AMEDDC&S published a matrix listing lesson plans (LP) and courses that 

identify the tasks related to AR 190-8 (Cit. 6); however, AR 190-8 is cited in only one 

recent LP from the 91W10 course (Cit. 1). The regulation is stated as a reference in 

one exportable training package (Cit. 3). The most cited training reference in all 

courses on medical records is AR 40-66. 

f. There is no exportable training specific to detainee medical records. 

g. PAD officers and administrative specialists assigned to (Table of Organization and 

Equipment (TOE)) units are not afforded sufficient training opportunities to sustain their 

Area of Concentration (AOC) or MOS skills. The resulting lack of proficiency affects 

their capability to correctly maintain detainee records. 

6-3. Discussion 

a. General Questionnaire. Question 69. Have you received MOS or other school 

training about detainee medical records? 

(1) The responses for OEF, GTMO and OIF, for past, present and future 

deployers, in the AC and RC combined, are presented in Table 6-1. 

Table 6-1. Question 69. Have you received MOS or other school training on 

detainee medical records? [for AClUSARlNG combined]. 

YES NO UNK NIA 

OEF -Past (63) 

OEF -Present (14) 

OEF -Future (26) 

GTMO -Past (2) 

GTMO -Present (7) 

OIF -Past (729) 

OIF -Present (52) 

OIF -Future (84) 
(2) AC and RC Response 

(a) AC. Overall, 2.9% of 710 interviewees (past and present) and 2.7% of 73 

(future) interviewees reported receiving MOS or other school training on detainee 

medical records. 

(b) RC. Overall, 7% of 157 interviewees (past and present) and 0% of 37 (future) 

reported receiving MOS or other school training on detainee medical records. 

b. Student Questionnaire. A total of 166 student questionnaires were completed at 

the AMEDDC&S, encompassing the OBC, 91G, 91W, 91WM6, and 91X students, as in 

Table 6-2. For all courses, the instruction had included training in the Geneva 

Conventions, the Law of War, and AR 190-8. Questionnaires were not executed for the 

Career Captains Course (CCC) as they had not received the training during the time 

period of the assessment. The results for questions pertinent to detainee medical 

records are presented in Tables 6-2 through 6-5. Students responding "yes" to question 

603 (Table 6-3) were asked questions 608 and 61 1. 

Table 6-2. Students participating in the Student Questionnaire. 

Course Number of Students Week in Course 

OBC Week 10 

91G Week 5 

91 W Week 15 

91 WM6 Week 6 

91X Week 10 

Table 6-3. Question 603. At this point in your current course, has the training 

included AR 190-8 (Enemy Prisoners of War (EPW), Retained Personnel (RP), 

Civilian Internees (CI), and other Detainees). 

YES NO UNK NIA 

OBC (40) 33 (83%) 4 (10%) 3 (8%) 0 (0%) 

91G (20) 6 (30%) 13 (65%) 1 (5%) 0 (0%) 

91 W (74) 

91 WM6 (1 7) 

57 (77%) 

11 (65%) 

12 (1 6%) 

4 (24%) 

5 (7%) 

2 (12%) 

0 (0%) 

0 (0%) 

91X (15) 2 (13%) 7 (47%) 5 (33%) 1 (7%) 
Table 6-4. Question 608. Did the training include requirements for medical 

records keeping for a detainee population? 

YES NO UNK NIA 

OBC (33) 20 (61 %) 10 (30%) 3 (9%) 0 (0%) 

91G (6) 3 (50%) 3 (50%) 0 (0%) 0 (0%) 

91 W (57) 12 (21%) 31 (54%) 14 (25%) 0 (0%) 

91 WM6 (1 1) 3 (27%) 6 (55%) 2 (18%) 0 (0%) 

91X (2) 0 (0%) 1 (50%) I(50%) 0 (0%) 

Table 6-5. Question 611. To what extent did the training raise your comfort level 

with accurately documenting medical records on a detainee? 

Excellent Good Neutral Fair Poor None 

OBC (33) 0 (0%) 9 (27%) 9 (27%) 9 (27%) 5 (15%) 1 (3%) 

91G (6) 1 (33%) 2 (1 7%) 3 (50%) 0 (0%) 0 (0%) 0 (0%) 

91 W (57) 0 (0%) 12 (21%) 15 (26%) 8 (14%) 11 (19%) 11 (19%) 

91 WM6 (1 1) 0 (0%) 1 (9%) 5 (45%) 1 (9%) 4 (36%) 0 (0%) 

91X (2) 0 (0%) I(50%) 0 (0%) 0 (0%) 0 (0%) I(50%) 

c. LPs and Course Content (Cit. 6) 

(1) LPs in the following professional development courses and MOS specific 

courses were reviewed: OBC, CCC, ACIRC Basic Non-commissioned Officer (BNCOC), 

Advanced Non-commissioned Officer Course (ANCOC), Medical Evacuation Doctrine 

Course, Flight Medic Course, Combat Casualty Care Course (C4), and Preventive 

Medicine Courses. None of these courses actually cite AR 190-8 or any DoD detention 

regulation outside of the DA 40 series regulations. The course content does address 

tasks related to AR 190-8; for example, General Protection Policy, captivity of EPWIRP, 

evacuation and care of EPW and RP, operation of EPW internment facilities and 

management, punitive jurisdiction, transfer of Prisoners of War, and medical care and 

sanitation. Other specialty courses offer medical ethics, ethical decision making, or 

ethics theory presentations. Only one LP, the International Humanitarian Law and the 

Geneva Conventions draft LP (draft dated 30 March 2005), which is taught into the 

91W10 course, cites AR 190-8 (Cit. 1). 

(2) The AMEDDC&S Doctrine and Training Development's new exportable 

training package, Medical Ethics of Detainee Care, cites AR 190-8. The exportable 

training package presentation mentions that documentation on medical records for 
detainees is the same as for U.S. Soldiers, citing AR 40-66 as the reference. Although 

AR 190-8 is stated in the presentation, the tasks required to document medical 

screening, generation, storage and collection of detainee medical records are not 

stated. AR 40-66 is also in many of the courses' programs of instruction (POI). It is 

unknown if the content of MEDCOM memorandum entitled "Deployment Medical 

Documentation GuidanceIReporting Requirements" (office symbol MCHS-I, undated 

and unsigned) provides guidance and establishes procedures and responsibilities 

specific to detainee inpatient and outpatient records (Cit. 32). The content of this 

memorandum is not taught in any of the courses outside of the "PAD Just-in-Time 

Deployment Training" course. 

d. PAD Training 

(1) The course director and the assistant course director at the 70E course were 

interviewed. They provided a draft itinerary of the PAD "Just-in-Time Deployment 

Training" course (Cit. 4) and a copy of the slides for a course entitled "Medical 

Documents in Combat and Contingency Operations" (Cit. 5). The objectives of the 

course are to "(1) identify U.S. Army policies regarding medical records ownership and 

custody in accordance with (IAW) AR 40-66, (2) identification of the deployment 

management process of the Adult Preventive and Chronic Care Flow sheets (DA2766) 

and (3) the purpose and management of field and 'drop' files." Subsequent slides 

discuss the forms that make up the "field" file, inpatient treatment record, and "drop" file. 

The course also stressed that, if the TheaterIArea of Responsibility (AOR) surgeon 

considers it impractical, the inpatient treatment record will not be used. Indications for 

use of Field Medical Card (DD1380) are presented in the course. 

(2) PAD officers expressed concerns about maintaining proficiency for TOE 70E 

and 91G personnel. Skills training and sustainment have not been a unit priority. Other 

unit duties and responsibilities of these medical personnel have limited their 

opportunities for training. One officer reported developing a program to ensure her 

91G personnel received proficiency training prior to deployment. The resulting lack of 

proficiency affects their capability to correctly maintain detainee records. 

6-4. Recommendations 

a. AMEDDC&S should ensure standardization of training of detainee healthcare 

documentation and disposition of retired detainee records across the entire healthcare 

spectrum in all theaters, from the point of capture and collection point to the detention 

facilities. 

b. Establish a team under the direction of the AMEDDC&S comprised of clinicians 

and PAD expertise with exceptional knowledge of the generation, storage, 

maintenance and collection (disposition) of detainee medical records from the point of 

capture, collection point to the detention facilities. The tasks and training content should 

be developed by this team. The AMEDDC&S should facilitate this process. 
(1) The above team should analyze courses' Pols and LPs to determine training 

gaps in the generation, storage and collection of detainee medical records. 

(2) The training should include a crosswalk of Geneva Conventions, DoD and DA 

regulations and policies pertaining to the generation, storage and collection of detainee 

medical records. Training content should be regularly revised to reflect changes in the 

policies. 

(3) The training structure should include all levels of care, from point of capture 

and the collection point to the detention facilities. Training should incorporate ACIRC 

Table of Distribution and Allowance (TDA) and TOE medical units and medical assets in 

MP and maneuver units. 

c. Create and deploy an exportable training package specific to the generation, 

storage and collection of detainee medical records for medical personnel in ACIRC TDA 

and TOE medical units. Medical assets assigned to ACIRC MP and maneuver units 

should receive the training package. 

d. PAD officers and senior PAD specialists should serve as the SMEs and training 

resource for ACIRC level II and Ill units. The physician assistant (PA) or senior 91 W 

should serve as the training resource for non-medical units. 

e. Incorporate training that is focused on the generation, storage and collection of 

detainee medical records into the 70E and 91 G courses. 

f. Expand PAD "Just-in-Time Deployment Training" course to include deploying RC 

70E and 91G personnel. 

g. Develop sustainment and proficiency training for 70E and 91 G personnel in 

ACIRC units. Training and proficiency data for 70E and 91G personnel should be 

competency-based and reported regularly as part of the unit's readiness report. 

Section Ill 

Training Received Regarding Medical Reporting of Detainee Abuse 

6-5. Findings 

a. 94% or more of medical personnel report familiarization with the Geneva 

Conventions. 

b. 97.5% of OBC Army Nurse officers surveyed reported receiving training on 

Geneva Conventions and Law of War. See Table 6-10. 

(1) Approximately one-quarter of the students enrolled in the 91G course reported 

receiving Geneva Conventions and one-third reported receiving Law of War training. 
(2) Eighty-five percent (85%) of students in the 91W course reported receiving the 

Geneva Conventions training, although little more than one-half of the students reported 

receiving Law of War training. 

(3) Fifty-nine percent (59%) of 91WM6 students reported receiving Geneva 

Conventions and less than half reported receiving Law of War training. 

(4) Two of the 15 91X students reported receiving Geneva Conventions training 

and three of the fifteen students reported receiving Law of War training. 

e. Less than half of all students reported that training included a process of medical 

reporting for suspected detainee abuse. Students who reported receiving the training 

reported that the training raised their comfort level with medical reporting of suspected 

detainee abuse. Refer to Tables 6-14 and 6-15 to view students' responses. 

f. The LPs listed in the AMEDDC&S Review of Institutional Training matrix do not 

discuss actual or suspected abuse. The plans also do not contain case studies or 

scenarios requiring students to apply newly learned concepts to situations in which 

abuse may not be readily apparent. There are no known "approved" scenarios or case 

studies that role play actual or suspected abuse and the reporting process. LPs do not 

address the care and the complexity of care and resources at the point of capture, 

collection point and at detention facilities. AR 190-8 is cited as a reference in LP but 

cited in only one presentation. 

g. There are no pocket training aids to serve as a quick reference training guide for 

students or deploying medical units that identify medical personnel responsibilities for 

reporting actual or suspected abuse of detainees. 

h. There is no evidence that training content has been developed and or vetted by 

Service members with exceptional knowledge of detainee care at the point of capture, 

collection point and detention facilities with representation from a judge advocate, a 

medical ethicist, and SME serving in the prison health care system. 

i. Several LPs have been recently updated. Lectures such as medical ethics have 

been added. 

6-6. Discussion: 

a. General Questionnaire. Tables 6-6 through 6-15 depict responses to questions 

pertaining to training received regarding medical reporting of detainee abuse. 

(1) Question 51. Have you received MOS or other school training about reporting 

possible detainee abuse? 

(a) For ACIUSARING combined, data is presented in Table 6-6 
Table 6-6. Question 51. Have you received MOS or other school training about 

reporting possible detainee abuse? [for ACIUSARING combined]. 

YES NO UNK NIA 

OEF -Past (63) 9 (14%) 52 (83%) 2 (3%) 0 (0%) 

OEF -Present (1 5) 1 (7%) 12 (80%) 2 (15%) 0 (0%) 

OEF -Future (25) 4 (16%) 21 (84%) 0 (0%) 0 (0%) 

GTMO -Past (2) 1 (50%) 1 (50%) 0 (0%) 0 (0%) 

GTMO -Present (7) 2 (29%) 5 (71 %) 0 (0%) 0 (0%) 

OIF -Past (738) 108 (1 5%) 6 13 (83%) 17 (2%) 0 (0%) 

OIF -Present (55) 6 (11%) 49 (89%) 0 (0%) 0 (0%) 

OIF -Future (85) 27 (32%) 56 (66%) 2 (2%) 0 (0%) 

In all categories of personnel, 50% or more had not received this school training. 

(b) AC and RC responses 

(i) AC. 14% of 721 surveyed (past and present) and 30% of 72 (future) surveyed 

reported receiving MOS or other school training about reporting possible detainee 

abuse. 

(ii) RC. 13% of 159 surveyed (past and present) and 21% of 38 (future) surveyed 

reported receiving MOS or other school training about reported possible abuse. 

(2)Responses to other questions pertaining to training received regarding medical 

reporting of detainee abuse are in Tables 6-7to 6-1 5. 
Table 6-7. Question 1. Are you familiar with the Geneva Conventions? 

YES NO UNK N/A 

OEF -Past (63) 

OEF -Present (14) 

63 (1 00%) 

14 (1 00%) 

0 (0%) 

0 (0%) 

0 (0%) 

0 (0%) 

0 (0%) 

0 (0%) 

OEF -Future (25) 26 (100%) 0 (0%) 0 (0%) 0 (0%) 

GTMO -Past (2) 

GTMO -Present (7) 

2 (100%) 

7 (1 00%) 

0 (0%) 

0 (0%) 

0 (0%) 

0 (0%) 

0 (0%) 

0 (0%) 

OIF -Past (735) 730 (99.3%) 2 (0.3%) 3 (0.4%) 0 (0%) 

OIF -Present (55) 

OIF -Future (88) 

54 (98%) 

83 (94%) 

0 (0%) 

4 (5%) 

1 (2%) 

1 (1%) 

0 (0%) 

0 (0%) 

In all categories of personnel, 94% or more were familiar with the Geneva Conventions. 

Table 6-8. Question 2. In preparation for providing detainee care did your unit 

use case studies? 

YES NO UNK NIA 

OEF -Past (63) 17 (27%) 41 (65%) 5 (8%) 0 (0%) 

OEF -Present (1 3) 2 (15%) 11 (85%) 0 (0%) 0 (0%) 

OEF -Future (26) 18 (69%) 5 (19%) 3 (12%) 0 (0%) 

GTMO -Past (2) 1 (50%) 1 (50%) 0 (0%) 0 (0%) 

GTMO -Present (7) 5 (71%) 2 (29%) 0 (0%) 0 (0%) 

OIF -Past (723) 147 (20.3%) 501 (69.2%) 72 (9.9%) 3 (0.4%) 

OIF -Present (52) 11 (21%) 37 (71 %) 4 (8%) 0 (0%) 

OIF -Future (85) 26 (31 %) 50 (59%) 8 (9%) 1 (1 %) 

In all categories, there is an increasing trend of using case studies in this training from 

past to present to future deploying personnel. 
Table 6-9. Question 3. Did your overall unit training prepare you for addressing 

human rights issues of detainees? 

YES NO UNK N/A 

OEF -Past (63) 45 (71 %) 17 (27%) 1 (2%) 0 (0%) 

OEF -Present (14) 

OEF -Future (26) 

6 (43%) 

22 (85%) 

0 (57%) 

3 (12%) 

0 (0%) 

1 (4%) 

0 (0%) 

0 (0%) 

GTMO -Past (2) 2 (100%) 0 (0%) 0 (0%) 0 (0%) 

GTMO -Present (7) 6 (86%) 1 (14%) 0 (0%) 0 (0%) 

OIF -Past (734) 473 (64%) 237 (32%) 24 (3%) 0 (0%) 

OIF -Present (55) 33 (60%) 21 (38%) 1 (2%) 0 (0%) 

OIF -Future (87) 54 (62%) 28 (32%) 4 (5%) 1 (1 %) 

Except for present OEF personnel (43%), 60% or more of the personnel felt their unit 

training prepared them for addressing human rights issues of detainees. 

b. Student Questionnaire. The results for questions pertinent to training received 

regarding medical reporting of detainee abuse are presented in Tables 6-10 through 6-

15. 

Table 6-10. Question 601. At this point in your current course, has the training 

included the Geneva Conventions? 

YES NO UNK N/A 

OBC (40) 39 (97.5%) 1 (2.5%) 0 (0%) 0 (0%) 91G (20) 5 (25%) 9 (45%) 6 (30%) 0 (0%) 

91 W (74) 63 (85%) 8 (11%) 3 (4%) 0 (0%) 

91 WM6 (1 7) 10 (59%) 6 (35%) 1 (6%) 0 (0%) 

91X (15) 2 (13%) 6 (40%) 6 (40%) 1 (7%) 

For 91G and 91X courses, one-quarter or less of the students recalled receiving training 

on the Geneva Conventions. 
Table 6-1 1. Question 609. Did the training include the specifics of medical 

reporting of detainee abuse? Answers for students responding "yes" to Question 

601 who answered this question. 

YES NO UNK N /A 

OBC (39) 16 (41%) 19 (49%) 4 (10%) 0 (0%) 

91G (4) 2 (50%) 2 (50%) 0 (0%) 0 (0%) 

91 W (63) 22 (35%) 31 (49%) 10 (16%) 0 (0%) 

91 WM6 (1 0) 6 (60%) 3 (30%) I(IOYo) 0 (0%) 

91X (2) 0 (0%) 2 (1 00%) 0 (0%) 0 (0%) 

Responses for 91G and 91X are unreliable due to small sample size. For the other 

courses, except for 91 WMG (60%), less than half of the students recalled receiving this 

training. 

Table 6-12. Question 612. To what extent did the training raise your comfort level 

with medical reporting of detainee abuse? Answers for students responding 

"yes" to Question 601 who answered this question. 

Excellent Good Neutral Fair Poor None 

OBC (39) 1 (3%) 13 (33%) 1 1 (28%) 8 (21 %) 4 (10%) 2 (5%) 

91G (5) 

91 W (60) 

1 (20%) 

0 (0%) 

2 (40%) 

13 (22%) 

2 (40%) 

17 (28%) 

0 (0%) 

10 (1 7%) 

0 (0%) 

9 (1 5%) 

0 (0%) 

11 (18%) 

91 WM6 (1 0) 0 (0%) 3 (30%) 4 (40%) 1 (10%) 0 (0%) 2 (20%) 

91X (2) 0 (0%) 0 (0%) 0 (0%) I(50%) 0 (0%) I(50%) 

Responses for 91G and 91X are unreliable due to small sample size. Overall, the 

training did not produce a good or excellent comfort level for reporting detainee abuse. 

Table 6-13. Question 602. At this point in your current course, has the training 

included the Law of War? 

YES NO UNK NIA 

OBC (40) 40 (1 00%) 0 (0%) 0 (0%) 0 (0%) 91G (20) 7 (35%) 12 (60%) 1 (5%) 0 (0%) 

91 W (74) 42 (57%) 14 (19%) 18 (24%) 0 (0%) 

91 WM6 (1 7) 7 (41 %) 7 (41%) 3 (18%) 0 (0%) 

91X (15) 3 (20%) 6 (40%) 5 (33%) 1 (7%) 

For 91G and 91X courses, one-third or less of the students recalled receiving training 

on the Law of War. 
Table 6-14. Question 609. Did the training include the specifics of medical 

reporting of detainee abuse? Answers for students responding "yes" to Question 

602 who answered this question. 

YES NO UNK NIA 

OBC (40) 17 (43%) 19 (48%) 4 (10%) 0 (0%) 

91G (6) 3 (50%) 3 (50%) 0 (0%) 0 (0%) 

91W (42) 16 (38%) 19 (45%) 7 (17%) 0 (0%) 

91WM6 (7) 5 (60%) 2 (71%) 0 (29%) 0 (0%) 

91X (3) 1 (33%) 2 (67%) 0 (0%) 0 (0%) 

Responses for 91X are unreliable due to small sample size. For the other courses, 

except for 91WMG (60%), half or less of the students recalled receiving this training. 

Table 6-1 5. Question 612. To what extent did the training raise your comfort level 

with medical reporting of detainee abuse? Answers for students responding 

"yes" to Question 602 who answered this question. 

Excellent Good Neutral Fair Poor None 

OBC (40) 1 (3%) 13 (33%) 1 1 (28%) 9 (21%) 4 (10%) 2 (5%) 

91G (7) 2 (29%) 2 (29%) 2 (29%) 0 (0%) 0 (0%) 1 (14%) 

91W (41) 0 (0%) 8 (20%) 11 (27%) 9 (22%) 5 (12%) 8 (20%) 

91WM6 (7) 1 (1 1 %) 2 (22%) 3 (33%) 1 (1 1 %) 1 (1 1 %) 1 (1 1 %) 

91X (2) 0 (0%) 1 (33.3%) 0 (0%) 1 (33.3%) 0 (0%) 1 (33.3%) 

Responses for 91X are unreliable due to small sample size. Overall, the training did 

not produce a good or excellent comfort level for reporting detainee abuse. 

(1) Comments from Surveyed Students. About half of the OBC and 91W and less 

than half of the 91WM6 students surveyed requested interactive real world examples 

through scenario based training. One student requested a pocket reference guide. 

Another student requested written and on-line references for further research on the 

subject matter. Many students desired more detail and complexity in the scenarios to 

provide them the opportunity to discuss the issues in depth. Students particularly 

wanted to hear the personal stories of the Soldiers and their experiences. 

(2) Program of InstructionslLPs. Review of the courses' Pols and LPs indicate 

that students attending professional development, MOS specific courses, and specialty 

courses do receive Geneva Conventions and Law of War training. LPs do not address 

physical and psychological examinationslmedical screening for abuse, cultural 
considerations and language barriers, use of interpreters and limitations, interrogations 

and medical personnel's responsibilities, detainee medical record documentation and 

disposition, emotional aspects in caring for detainees, signing of death certificates, 

distinguishing between abuse and lawful combat operations, and use of case studies or 

scenario-play (Table 20). 

d. Other AMEDD Center And School Training Products 

(1) Interviews with staff members at the Department of Training Support, AMEDD 

C&S, revealed a team dedicated to the Dean's charge to quickly move education and 

knowledge outside the Academy walls to the AMEDD population worldwide. In January 

2005, 200 sets of AMEDD training CDs were distributed to units in Iraq. The training 

products are provided on request from the field. As of 24 March 2005, Department of 

Training Support was processing orders from MEDCOM, Forces Command 

(FORSCOM), and USAR units in addition to Navy active duty units and personnel. The 

first set was completed in less than four weeks. The next goal is to develop current 

instructional materials into an exportable distance learning formats. Content will be 

reviewed yearly or sooner if required by the dynamic environment and needs of the 

AMEDD personnel (Cit. 3). 

(2) The Medical Ethics in Detainee Operations (Cit. 2) provides a cursory overview 

of the Just War Theory, explanation of the Red CrossIRed Crescent, challenging 

unlawful orders and war crimes, treatment of detainees under medical roles of care, 

battlefield triage and evacuation categories. Scenarios presented are easily 

recognizable as war crimes. The scenarios infer that Soldiers know that the order is 

unlawful and takes the reader through the steps to challenge the order and contact the 

chain of command. In contrast, more subtle incidents that present ethical and 

professional dilemmas such as a 91W fluent in Arabic in which he has been directed to 

question detainees by his medical Officer in Charge (OIC) to obtain more intelligence 

information or a medic that initiates intravenous therapy on a dehydrated detainee 

during an interrogation or a physician which obtains a buccal swab under the direction 

of the interrogator. The detainee is informed by the interrogator that the swab will link 

him to terrorist activities. These incidents are examples of incidents which could be 

incorporated into LPs for further probing and discussion by students and instructors. 

6-6. Recommendations 

a. Tools should be introduced to assist students in recalling their training; for 

example, a reference pocket training aid. The tool should display a decision algorithm 

to assist them in distinguishing actual or suspected abuse from injuries as a result of 

lawful combat operations. 

b. AMEDDC&S, as the proponent for training of medical personnel in detainee 

healthcare (to include medical reporting of detainee abuse) across the entire healthcare 

spectrum in theater, from the point of capture and collection point to a detention facility 

should: 
(1) Establish a SME team to develop the tasks and framework to build a 

comprehensive AMEDD training program. The framework should include all training 

platforms (Mobilized Unit lnprocessing Centers (MUIC), Reserve Training Sites (RTS), 

NTC, JRTC, and PPP sites) and methods of instruction (lecture, case studies, scenario, 

after action review (AAR)). The framework must encompass all levels of care, from 

point of capture to a detention facility. The framework must serve as an additional 

resource for TOE medical units and TDA facilities as part of the readiness component. 

(2) SME Team membership should include appropriate representation from the 

RC and should have exceptional knowledge of detainee care at the point of capture, 

collection point and detention facilities. Additionally, the team should be comprised of a 

judge advocate, a medical ethicist, and SMEs serving in the prison health care system. 

The tasks and training content should be standardized particularly in the professional 

development and MOS specific courses. 

(3) MOS-specific schools and professional development courses should 

incorporate case studies and scenario-based training on current Army operations 

Training Centers, such as NTC and JRTC, should be provided with the means to 

provide realistic level I to level Ill detainee medical care training. 

(4) Consider using regularly scheduled video teleconferences with 91 W, 91WM6 

students and Soldiers that experienced detainee care from the point of capture, 

collection point or detention facility to enhance learning followed with a Q and A format. 

(5) Revise the existing exportable training package to include all tasks 

associated with detainee care. Incorporate selected incidents and allegations to serve 

as case studies or scenario play. The AMEDDC&S should facilitate development of the 

training package and push the products out. 

c. MEDCOM should provide all medical senior leaders (ACIRC) detention care 

policies, regulations and references which could be accessed through the Army 

Knowledge Online (AKO) site. MEDCOM should continually update AKO so that 

evolving guidance, tools and references are current. The following criteria and content 

(not all inclusive) should be considered: 

(1) Theater accessible. 

(2) Approved for continuing education credit. 

(3) Approved detention care competency tools, 

(4) DoD detention care guidance, 

(5) DA guidance relating to detention care. 
(6) "Health Professional's Guide to Medical and Psychological Evaluation of 

Torture by Physician for Human Rights" as an example (Cit. 38). 

d. DoD-I 1322.24, "Medical Readiness Training" (12 July 2002) (Cit. 21) should include 

detention care competencies. Competencies should be developed by SMEs 

possessing exceptional knowledge of detainee care at the point of capture, collection 

point and detention facilities and the prison health care system. 
Chapter 7 

Question d. Was there any policy guidance, OPORDER, SOP, or other authority 

establishing criteria for providing detainee medical support andlor care in the 

theater of operation? 

7-1. General Findings 

a. Present DA and DoD guidance regarding the standard of care for detainees has 

gaps, at times is ambiguous, and is not specific enough. 

b. Many "Yes" respondents were unable to specifically identify policies or 

regulations, or provide details of the guidance contained therein. 

c. AR 40-400 provides the best statement regarding health care standards. 

7-2. Operation Enduring Freedom Findings 

a. The Team found no evidence of specific theater-level policies for detainee 

medical operations in OEF until 2004. 

b. 47% of past and 60% of current OEF personnel answered "Yes" to question (d) 

above. 

7-3. Guantanamo Bay Detention Facility Findings 

a. There have been numerous theater-levellfacility policies for detainee medical 

operations since early 2003 (Cit. 26). 

b. 100% of past and current GTMO personnel answered "Yes" to question (d) above. 

c. All medical personnel interviewed on-site at GTMO were very well-versed in 

appropriate policies and procedures. 

7-4. Operation Iraqi Freedom Findings 

a. The team found no evidence of specific theater-level policies for detainee medical 

operations in OIF until 2004. 

b. 56% of past and 88% of current OIF personnel answered "Yes" to question (d) 

above. 

c. The current organization of detainee medical operations is under TF 134 

d. TF 134 has developed broad policy and guidelines for detainee medical care. 
7-5. Discussion 

a. The Team found evidence of confusion among medical personnel, both leaders 

and subordinates, of the required level of care for detainees. This confusion is 

explained by the use of different classifications for detained personnel. As discussed in 

paragraph 7-5d below, the guidance on the standard of care varies for different 

classifications of detainees. 

b. Two Combat Support Hospital (CSH) Commanders (Interviewees # 634 and 715) 

stated they were instructed by their higher headquarters to provide detainee medical 

care based on local Iraqi standards. Despite this incorrect guidance, both CSHs 

provided detainees the correct level of care as stated in paragraph 7-5d(3) below. 

c. Theater level guidance was not provided in a timely manner to deploying OEF and 

OIF medical units or personnel. Some units developed their own policies for providing 

detainee medical care, including most CSHs and TF Oasis. DoD and DA guidance is 

outlined below: 

d. Present DoD and DA Guidance 

(1) Health Affairs (HA) Policy 02-005, Medical Care for Enemy Persons under U.S. 

Control Detained in Conjunction with Operation Enduring Freedom, dated April 2002 

(Cit. 28), states that medical care shall be provided consistent with AR 190-8 to the 

extent appropriate. The phrase "to the extent appropriate" is ambiguous. The policy 

also states that care for detainees shall be guided by standards "similar to those that 

would be used to evaluate medical issues for US personnel." The adoption of a 

"similar standard" is also ambiguous. HA Policy 02-005 references DoD Directive 

2310.1, DoD Program for Enemy Prisoners of War and other Detainees, dated August 

1994 (Cit. 22). DoD Directive 2310.1 does not include any specific information related 

to medical care. 

(2) AR 190-8, Enemy Prisoners of War, Retained Personnel, Civilian Internees, 

and Other Detainees, dated October 1997 (Cit. 1 I), presently contains the most detailed 

guidance on medical care to individuals under U.S. control. However, the vast majority 

of the brief medical information contained in this AR (Section 6-6) only pertains to Cls. 

The stated standard is "The treatment must be as good as that provided for the 

general population." It is not clear if this section is intended to apply to all classes of 

detained persons. Medical information elsewhere in this AR pertaining to other classes 

of detainees is inadequate. 

(3) AR 40-400, Patient Administration, dated March 2001 (Cit. IO), contains the 

clearest statement of the Army standard of medical care for detainees. Paragraph 3-38 

states: "Members of the enemy armed forces and other persons captured or 

detained by U.S. Armed Forces are entitled to medical treatment of the same kind 

and quality as that provided U.S. Forces in the same area." Although misplaced 

(AR 40-3 and AR 190-8 would be the logical locations), this is a succinct statement that 
is easy to comply with and understand. Not one single interviewee, nor any Team 

member prior to this assessment, knew of the existence of paragraph 3-38. 

(4) AR 40-3, Medical, Dental, and Veterinary Care, dated November 2002 (Cit. 8), 

and AR 40-66, Medical Records Administration and Health Care Administration, dated 

July 2004 (Cit. 9 ), contain no guidance regarding detainee care. 

(5) Secretary of Defense (SECDEF) Memorandum, SUBJECT: Procedures for 

Investigation into Deaths of Detainees in the Custody of the Armed Forces of the U.S., 

dated June 2004 (Cit. 41), clearly states the procedures for death investigations for 

detainees in the custody of the Armed Forces, including the requirement for an autopsy. 

(6) Deputy Secretary of Defense Memorandum, SUBJECT: Policy Statement and 

Guidelines on Body Cavity Searches and Exams for Detainees under DoD Control, 

dated January 2005 (Cit. 20), provides clear direction on body searches. 

e. Operation Enduring Freedom 

(1) Combined Joint Task Force (CJTF) -76 BHA and KHA Detainee Medical 

Standard Operating Procedure (SOP), dated August 2004 (Cit. 17), contains some 

areas of very specific guidance (e.g. tuberculosis screening, sick call procedures, and 

inprocessing). However, some confusing paragraphs include: "patients with life, limb, or 

eye emergencies like heart attacks or stroke will be referred to the medic on duty and if 

the medic decides that the complaint can wait, the PUC will be seen the following day," 

and one paragraph describing the assessment of detainees prior to interrogation. 

(2) Bagram SOP, Annex W-I, dated September 2004 (Cit. 12), contains two 

pages on specific medical issues, including: in-processing, sick call, monthly exams, 

GTMO transfer, pharmacy, and preventive medicine. Medical screening and exam 

forms have been developed. 

(3) CJTF-76, Detainee Operations SOP'S, Bagram (Secret), dated January 2005, 

has minimal information on medical care but includes: (U) "Care will be provided to 

the same extent provided by CJTF-76 to its own forces." Other medical issues 

covered include: sick call, hunger strikes, the taking of photos, and access to medical 

records.' 

(4) U.S. Southern Command (USSOUTHCOM) Confidentiality Policy for 

Interactions between Health Care Providers and Enemy Persons under U.S. Control, 

Detained in Conjunction with OEF, dated August 2002 (Cit. 42), references AR 190-8 

and the Geneva Conventions, but contains vague and potentially ambiguous wording: 

"Only those individuals identified as requiring knowing the detainee's medical condition will have access 

to the medical records." The SOP does not define the criteria used to determine who has a "need to 

know." 

1 
(a) This policy states "Medical care is provided under conditions and for 

purposes similar to those applicable to military correctional facilities," without 

citing any references to support this standard. 

(b) The standard in 3(a) above has been supplemented by the USSOUTHCOM 

Policy on Health Care Delivery to Enemy Persons Under U.S. Control at U.S. Naval 

Base Guantanamo Bay, Cuba, dated 9 August 2004. Paragraph 10c states: "Medical 

care and treatment shall be provided whenever necessary." Paragraph log states: 

"U.S. accepted standards of medical care (current practice guidelines) are used." 

f. Guantanamo Bay Detention Facility 

(1) USSOUTHCOM Policy on Healthcare Delivery to Enemy Persons under U.S. 

Control at US Naval Base, Guantanamo Bay, Cuba, dated August 2004 (Cit. 43), 

includes: "US.accepted standards of medical care are used." 

(2) There are numerous SOPS from the Detainee Hospital, GTMO, from 2003 and 

2004 (Cit. 27). Several specific ones that could be referred to in the future as potential 

standards in all theaters include: Detainee Weight Management and Nutrition Program, 

In-Processing Medical Evaluation, Detainee Refusal of Care, and Vaccinations. 

g. Operation Iraqi Freedom 

(1) ANNEX Q (Medical Services) to U.S Army Central Command (USARCENT) 

Operation Plan (OPLAN) 1003-96 (Secret), dated April, 1997: (U) "Provide health 

services for Cl's and EPW's at established camps as governed by customary and 

conventional international law." It does not specifically reference AR 190-8, nor does 

it explain what is meant by this statement. 

(2) Appendix 7 (Medical) to ANNEX I to V Corps OPLAN 1003 (Secret), dated 

December, 1998: (U) "EPWs, Cls, and Detained Persons (DETS) are provided 

medical treatment on the same basis as US sick and wounded. Medical factors 

are utilized to determine the priority of treatment." 

(3) Fragmentary Order (FRAGO) 1206 to CJTF-7 Operation Order (OPORD) 03- 

036 (Secret), dated December 2003, states: (U) "Establish and staff a 50 bed facility 

which will provide level I-Ill care for security detainees IVO Abu Ghraib NLT 15 

February 2004." 

(4) FRAGO 20 to FORSCOM Deployment Orders in Support of OIF-2 (Secret), 

dated May 2004, (U) recognizes and addresses the shortfall of not having a dedicated 

level Ill facility specifically for detainee care. 

(5) Camp Bucca SOP, dated June 2004, sec. 4-4: "Detainee Medical Procedures" 

(Cit. 14), covers numerous areas in generalities, including: roles of different medical 

personnel, in-processing, sick call, medical records (access shall be restricted and 
governed IAW AR 340-16 and 340-21), medical evacuation, detainee deaths, 

preventive medicine operations, and dental care. 

(6) Appendix 2 (Medical Care for Detainee Operations) to ANNEX Q (Health 

Services Support) to Multinational Corps, lraq (MNC-I) CAMPAIGN PLAN: OIF (Secret), 

dated August 2004. 

(7) ANNEX Q (Health Services Support) to USCENTCOM OPORDER 11 to MultiNational Forces-Iraq (MNF-I) (Secret), dated December, 2004, includes: (U) "EPWs, 

Cls, and SDs (Security Detainees) will be provided medical treatment on the same 

basis as Multinational Forces, lraq (MNF-I) sick and wounded, and IAW existing 

treaties, international law, and the Geneva Convention. Standard military triage 

protocols will be used to determine the priority of treatment to be administered. To the 

extent possible, EPWs, Cls, and SDs will be treated in separate wards from MNF-I 

patients, subject to physical constraints. Detained enemy medical personnel may be 

used as much as possible in the care of EPW's." 

(8) MNF-I Policy 05-02, "Interrogation Policy" (Secret), encl.1, "Safeguards," dated 

January 2005, includes: 

(a) (U) "Detainee medical information will be protected in accordance with all 

applicable laws and regulations. Routine detainee healthcare is separated from 

interrogation operations. Healthcare providers for detained persons will not be required 

to verbally provide detainee medical information to intelligence collectors. This applies 

to all agencies conducting interrogations. Medical personnel shall provide interrogators 

such information as they believe necessary to protect the health and safety of the 

detainee or to prevent the commission of a crime." 

(b) (U) "Detained persons selected for interrogation must undergo a medical exam 

or assessment before the beginning of interrogation. The exam or assessment will 

record the physical and medical condition of the detainee and ensure the detainee is 

medically cleared to undergo interrogation." 

(c) (U) "No interrogation of hospitalized detained persons may be conducted 

without first obtaining the approval of DCGDOICommander, TF 134, in conjunction with 

the DCCS at the hospital." 

(d) (U) "Interrogation of wounded personnel will not delay or interfere with the 

evacuation of wounded personnel to the appropriate level of medical care." 

(9) OIF Theater Detention Healthcare Policy, dated January 2005, with multiple 

appendixes (Cit. 37); per Commander, Detainee Medical TF, and Commander, TF 44th 

MEDCOM; is very comprehensive and covers the major areas of detainee medical 

operations. 
(10) MNF-I SOP: Detainee Healthcare, dated February 2005 (Cit. 34); mirrors # 9 

above. 

(11) TF 134 Memorandum, SOP for Ensuring Separation of Detention Operations 

Functions, dated February 2005 (Cit. 46); reinforces the need to protect detainee 

medical information. 

7-6. Recommendations. 

a. Although not required by law, DA guidance (DoD level is preferable) should 

standardize detainee medical operations for all theaters, should clearly establish that all 

detained individuals are treated to the same care standards as U.S. patients in the 

theater of operation, and require that all medical personnel are trained on this policy and 

evaluated for competency. Specific areas of guidance should include, but are not limited 

to: 

(1) Initial and continual screening assessments 

(2) Medical care equal to standards for U.S. Soldiers in the theater of operation. 

(3) Informed consent. 

(4) Protection of detainee medical information. 

(5) Documentation in and handling of medical records. 

(6) Recognition, documentation, and reporting of suspected abuses. 

(7) Planning factors for medical resources required for detainee care 

b. All medical personnel must be trained on this guidance, with follow-up assessment 

of competency. 

c. Policies concerning detainee medical operations should be declassified to the 

greatest extent possible to allow for the widest application of recommendation (a) 

above. 

d. Classified policies should be archived on secure command web pages as they are 

updated or as new ones are added, since this will allow one to evaluate policy 

implementation timelines. 

e. Units having theater-level responsibilities (for example TF 134), should propagate 

DA or DoD guidance, with particular emphasis on units delivering level I or II care in 

their AOR. 
Chapter 8 

Question e. What unit training did the active component receive prior to 

deployment regarding the generation, storage and collection of detainee medical 

records' and the medical reporting of detainee abuse? 

Section I 

Operation Enduring Freedom 

8-1. Findings 

a. Training on Detainee Medical Records. Very few pastlpresent OEF interviewees 

received medical records training prior to deployment; 32% received this training in 

theater. For future OEF deployers, almost two-thirds of the interviewees received unit 

training at their home stations. 

b. Training on Detainee Abuse Reporting. Few pastlpresent OEF interviewees 

received detainee abuse reporting training prior to deployment; 42% received this 

training in theater. For future OEF deployers, most of the interviewees received unit 

training at their home stations. 

c. Few interviewees stated they had prior knowledge their deployment would include 

a detainee medical mission in theater. 

8-2. Discussion 

a. Training on Detainee Medical Records. 

(1) 38 AC pastlpresent OEF medical personnel were interviewed, 

(a) 5% reported receiving unit training at home station (Question 70). 

(b) 5% reported receiving unit training during mobilization (Question 71). 

(c) 32% reported receiving unit training in theater (Question 72). 

(2) Of 26 AC future OEF-deploying soldiers, 62% stated they received unit training 

at their home station about detainee medical records (Question 70). 

b. Training on Detainee Abuse Reporting. 

(1) 38 AC pastlpresent medical personnel were interviewed. 

(a) 18% reported receiving unit training at home station (Question 52) 

As noted in paragraph 6-2a, 2.8% of 692 AC interviewees surveyed (past and present) and 2.7% of 73 

(future) reported receiving MOS or other school training on detainee medical records. 

1 
(b) 24% reported receiving unit training during mobilization (Question 53) 

(c) 42% reported receiving unit training in theater (Question 54) 

(2) Of 26 AC future OEF-deploying soldiers, 92% stated they received unit training 

at their home station about reporting possible detainee abuse (Question 52). This large 

improvement over the pastipresent personnel, according to many future interviewees, is 

directly attributable to the publicity, and lessons-learned, from Abu Ghraib. 

Section II 

Guantanamo Bay Detention Facility (GTMO) 

8-3. Findings 

a. Training on Detainee Medical Records. Very few pastlpresent GTMO 

interviewees received medical records training prior to deployment; 71 % received this 

training in theater. 

b. Training on Detainee Abuse Repolting. Over 50% of pastipresent GTMO 

interviewees received detainee abuse reporting training prior to deployment; 71 % 

received this training in theater. 

c. lnterviewees were aware of their detainee mission prior to deploying, 

8-4. Discussion 

a. Training on Detainee Medical Records. 

(1) Seven AC pastlpresent GTMO medical personnel were interviewed: 

(a) 14% reported receiving unit training at home station (Question 70) 

(b) 0% reported receiving unit training during mobilization (Question 71). 

(c) 71% reported receiving unit training in theater (Question 72). 

(2) No interviews were conducted on GTMO future deploying individuals. 

b. Training on Detainee Abuse Reporting. Training on detainee abuse reporting 

(1) Seven AC pastlpresent GTMO medical personnel were interviewed: 

(a) 57% reported receiving unit training at home station (Question 52). 

(b) 71% reported receiving unit training during mobilization (Question 53) 
(c) 71% reported receiving unit training in theater (Question 54). 

(2) No interviews were conducted on GTMO future deploying individuals 

Section IV 

Operation Iraqi Freedom 

8-5. Findings 

a. Training on Detainee Medical Records. Very few pastlpresent OIF interviewees 

received medical records training prior to deployment; 27% received this training in 

theater. For future OIF deployers, 27% of the interviewees received unit training at their 

home stations. 

b. Training on Detainee Abuse Reporting. Less than one-quarter of the pastlpresent 

OIF interviewees received detainee abuse reporting training prior to deployment; 40% 

received this training in theater. For future OIF deployers, 32% of the interviewees 

received unit training at their home stations. 

c. Most OIF interviewees stated they had no prior knowledge their deployment 

included a detainee mission in theater. Only one unit knew of a specific detainee 

mission awaiting them in theater. 

8-6. Discussion 

a. Training on Detainee Medical Records. Training on detainee medical records: 

(1) 644 AC pastlpresent OIF medical personnel were interviewed 

(a) 3% reported receiving unit training at home station (Question 70). 

(b) 5% reported receiving unit training during mobilization (Question 71) 

(c) 27% reported receiving unit training in theater (Question 72). 

(2) Of 47 AC future OIF deploying personnel interviewed, 15% stated they 

received unit training at their home station about detainee medical records (Question 

70). 

b. Training on Detainee Abuse Reporting. Training on detainee abuse reporting: 

(1) 658 AC pastlpresent OIF medical personnel were interviewed. 

(a) 18% reported receiving unit training at home station (Question 52) 
(b) 24% reported receiving unit training during mobilization (Question 53). 

(c) 40% reported receiving unit training in theater (Question 54). 

(2) Of 47 AC OEF future deploying soldiers, 32% stated they received unit training 

at their home station about reporting possible detainee abuse (Question 52). 

C, l-he pw2 personnel knew they were deploying to a specific detainee 

mission in theater before deploying; however, they did not conduct additional predeployment training related to detainee healthcare before departing for Iraq other than 

their mandatory PPP training. Strong hospital and company-level leadership combined 

with committed support from the 44th MEDCOM has helped offset this training oversight. 

The unit has helped draft the first comprehensive detainee healthcare operations 

policies and SOPS in OIF (Cit. 37). According to interviewees, other units not providing 

their soldiers with additional pre-deployment training have not fared as well in theater. 

Section VI 

Recommendations 

8-7. Overall Recommendations 

a. Leaders at all levels should conduct meaningful training and verify by following up 

with an assessment via a competency test, regardless of the unit's deployment status. 

This training should be documented and archived. Training should be pertinent to and 

specifically address standard of care and the generation, storage and collection of 

detainee medical records as well as recognizing and reporting detainee abuse. 

b. Specific standardized training requirements should be given to all medical units, 

ACIRC prior to deploying to a theater of operation. Particular attention needs to be 

given to the training guidance given by the AMEDD to medical personnel assigned to 

level I and level II medical units. 

c. All medical units should assume they will have a detainee healthcare mission 

when deploying and identify it as a METL-training requirement. 

d. Develop pre-designated medical units specifically identified to serve in detention 

facility roles in future operations. These units can tailor their training, both predeploymentlpre-mobilization, as well as during deploymentlmobilization, to this mission. 

Training should also focus on security procedures for medical personnel treating 

detainees and the physical and psychological stresses involved in detainee care. 
Chapter 9 

Question f. What training did reserve component soldiers receive at home station, 

power projection platforms and in-theater regarding the generation, storage and 

collection of detainee medical records' and the medical reporting of detainee 

abuse? 

Section I 

Operation Enduring Freedom 

9-1. Findings 

a. For RC pastlpresent OEF interviewees, no or minimal unit training was conducted 

on detainee medical records at the home station, during mobilization, or in theater. No 

future RC OEF deployers were interviewed. 

b. For RC pastlpresent OEF interviewees, less than one-quarter received unit 

training on detainee medical records at the home station, during mobilization, or in 

theater. No future RC OEF deployers were interviewed. 

c. None of the interviewees were aware they were deploying to a detainee mission in 

theater prior to deployment. 

9-2. Discussion 

a. Training on Detainee Medical Records: 

(1) 37 RC pastlpresent OEF medical personnel were interviewed: 

(a) 0% reported receiving unit training at home station (Question 70) 

(b) 3% reported receiving unit training during mobilization (Question 71). 

(c) 7% reported receiving unit training in theater (Question 72) 

(2) No future deploying RC units were interviewed. 

b. Training on Detainee Abuse Reporting: 

(1) 38 RC pastlpresent OEF medical personnel were interviewed: 

(a) 5% reported receiving unit training at home station (Question 52). 

(b) 21% reported receiving unit training during mobilization (Question 53) 

As noted in paragraph 6-2a, 1.2% of 39 RC interviewees surveyed (past and present) and 0% of 37 

(future) reported receiving MOS or other school training on detainee medical records. 

1 
(c) 16% reported receiving unit training in theater (Question 54). 

(2) No future deploying RC units were interviewed 

Section II 

Guantanamo Bay Detention Facility 

9-3. Findings 

Training on detainee medicals records and reporting detainee abuse was received by 

the two RC pastlpresent GTMO personnel interviewed. No RC future GTMO personnel 

were interviewed. 

9-4. Discussion 

a. Training on Detainee Medical Records. Oniy two RC pastlpresent GTMO 

personnel were interviewed. Both received unit training on detainee medical records at 

home station, during mobilization, and in theater. No RC future GTMO personnel were 

interviewed. 

b. Training on Detainee Abuse Reporting. Oniy two RC pastlpresent GTMO 

personnel were interviewed. Both received unit training on reporting detainee abuse at 

home station, during mobilization, and in theater. No RC future GTMO personnel were 

interviewed. 

Section Ill 

Operation Iraqi Freedom 

9-5. Findings 

a. For RC pastlpresent OIF interviewees, no or minimal unit training was conducted 

on detainee medical records at the home station or during mobilization; however, 40% 

received the training in theater. Only 3% of RC future OIF deployers received the 

training at their home unit. 

b. For RC pastlpresent OIF interviewees, approximately one-quarter received unit 

training on detainee medical records at the home station, during mobilization, or in 

theater. Only 13% of RC future OIF deployers received the training at their home unit. 

c. No interviewees stated they had prior knowledge of going into theater to perform a 

detainee-specific mission. 

9-6. Discussion 

a. Training on Detainee Medical Records 
(1) 112 RC past present OIF medical personnel were interviewed: 

(a) 4% reported receiving unit training at home station (Question 70) 

(b) 7% reported receiving unit training during mobilization (Question 71). 

(c) 40% reported receiving unit training in theater (Question 72). 

(2) Of 38 RC future OIF deploying personnel interviewed, 3% stated they received 

unit training at their home station on detainee medical records (Question 70). 

b. Training on Detainee Abuse Repolting: 

(1) 112 RC past present OIF medical personnel were interviewed: 

(a) 15% reported receiving unit training at home station (Question 52) 

(b) 27% reported receiving unit training during mobilization (Question 53) 

(c) 27% reported receiving unit training in theater (Question 54). 

(2) Of 39 RC future OIF deploying personnel interviewed, 13% stated they 

received unit training at their home station on reporting detainee abuse (Question 52). 

Section IV 

Overall Recommendations 

9-7. Overall Recommendations 

a. Leaders at all levels should conduct meaningful training, and verify by following up 

with an assessment via a competency test, regardless of the unit's deployment status. 

This training should be documented and archived. Training should be pertinent to and 

specifically address standard of care and the generation, storage and collection of 

detainee medical records as well as recognizing and reporting detainee abuse. 

b. Specific standardized training requirements should be given to all medical units 

prior to deploying to a theater of operations. Particular attention needs to be given to 

the training guidance given by the AMEDD to medical personnel assigned to level I and 

level II medical units. 

c. All medical units should assume they will have a detainee healthcare mission 

when deployed and identify it as a METL-training requirement. 

d. Develop pre-designated medical units specifically identified to serve in detention 

facility roles in future operations. These units can then tailor their training, both pre- 
deploymentlpre-mobilizations as well as during deployment/mobilization, to this unique 

mission. Training should also focus on security procedures for medical personnel 

treating detainees and the physical and psychological stresses involved in detainee 

care. 
Chapter 10 

Question g. Identify OEF and OIF Detention Medical Facilities 

10-1. Background 

a. In OIF and OEF, nearly all maneuver and MP units of any size participated to 

some extent in detainee operations. Participation depended on the type and size of the 

unit and included: 

(1) Point of Capture/Collection Point, 

(2) Brigade lnternment Facility (BIF). 

(3) Division lnternment Facility (DIF). 

(4) Prison. 

b. Medical personnel assigned to these units participated in detainee medical care 

along a continuum of care ranging from medical screening to acute trauma 

management and evacuation. 

c. At the maneuver Bn and Bde detainee holding facilities the duration of detention 

ranged from a few hours to several days. The involvement of medical personnel at 

these locations varied accordingly. 

10-2. Operation Enduring Freedom. There are two major detention facilities in 

Afghanistan, one each at Bagram and Kandahar. The diagrams in this chapter include 

medical and non-medical units that provided or are currently providing level I, II and Ill 

medical care for the detainees at these facilities. 

Bagram Holding Area 

Level 2 

OCT APR OCT APR OCT APR OCT APR 

2001 2002 2002 2003 2003 2004 2004 2005 
I Level 3 Kandahar Holding Area 

Level 2 

Level 1 

OCT APR OCT APR OCT APR OCT APR 

2001 2002 2002 2003 2003 2004 2004 2005 

10-3. Guantanamo Bay Detention Facility. There is a dedicated detainee hospital 

capable of providing level I, II and Ill care and a base Naval Hospital. The base hospital 

has a dedicated large 4-bed room available for detainees, capable of supporting critical 

care needs. Staffing is Tri-service. 

10-4. Operation Iraqi Freedom 

a. There are three prisons in Iraq: Camp Cropper (also known as Baghdad 

International Airport (BIAP) or High Value Detainee (HVD) detention facility), Abu 

Ghraib, and Camp Bucca. There are also three division level internment facilities in Iraq 

at Baghdad, Mosul, and Tikrit. The diagrams in this chapter include medical and nonmedical units that provided or are currently providing level I, II and Ill medical care for 

the detainees. 

b. In January 2004m~ed Bde (followed bm~ed Bde in February 2004) 

established TF Oasis to provide level II and Ill medical care for Abu Ghraib. The 

F! frnm the fnllnwlnnnits' 

b)(2)-2 I This was the first "detainee-only'' 

hospital built by the Army. It open€ ?d for inpatient occupancy on 18 March 2004. 

c. In August 2004, .(b'(2)~2 deployed to Abu Ghraib to further expand medical 

capabilities for detainees for level Ill and ultimately limited rehabilitative medical care. 

In October 2004, a slice of 'b"2'2 I(including medical personnel from t h e m 

rb)0-2]moved to Camp Bucca to establish level Ill care at that detention facility. 

I 
Level 3 Abu Ghraib Detention Facility 

Level 2 


MAR SEP MAR SEP MAR 

2003 2003 2004 2004 2005 


Baghdad (Camp Liberty) Detention Facility Level 3 


Level 2 


MAR SEP MAR SEP MAR 

2003 2003 2004 2004 2005 

Mosul Detention Facility Level 2 


MAR SEP MAR SEP MAR 

2003 2003 2004 2004 2005 


Tikrit (Camp Danger) Detention Facility Level 2 


MAR SEP MAR SEP MAR 

2003 2003 2004 2004 2005 

HVD (Camp Cropper) Detention Facility 

MAR SEP MAR SEP MAR 

2003 2003 2004 2004 2005 


Level 3 Camp Bucca Detention Facility 

Level 2 a 

Level 1 


MAR SEP MAR SEP MAR 

2003 2003 2004 2004 2005 

Chapter 11 

Question h. With respect to the detention medical facilities identified in 

subparagraph g immediately above, determine if the facility generated, stored and 

collected detainee medical records, to include records documenting medical 

support to any detainee being prepared for interrogation, being interrogated, or 

needing medical treatment as a result of, or immediately after, interrogation. 

11-1. Findings 

a. Guidance regarding criteria for pre- and post-interrogation medical screening is 

inconsistent. 

b. Medical care (including screenings) at or near the time of interrogations was 

neither consistently documented nor consistently included in detainee medical records. 

c. Some medical personnel were unclear whether interrogations could be continued 

if a detainee required medical care during the interrogation. 

d. Medical personnel at some locations felt empowered to halt interrogations for 

either medical or safety reasons. 

11-2. Discussion 

a. Operation Enduring Freedom 

(1) No interviewees reported being asked to provide medical care during 

interrogations so that the interrogations could be continued. No interviewees reported 

being aware of other medical personnel who were asked to do the same. 

(2) 38% (3 of 8) of interviewees who served at Bagram reported that preinterrogation screenings were completed. 25% (2 of 8) reported that post-interrogation 

screenings were completed. Those giving positive responses agreed that this 

information was always documented, but was not always included in the medical 

records. 

(3) 33% (3 of 9) of interviewees who served at Kandahar reported that preinterrogation screenings were completed. 11% (1 of 9) reported that post-interrogation 

screenings were completed. Those giving positive responses agreed that this 

information was always documented and was always included in the medical records. 

b. Guantanamo Bay Detention Facility 

(1) No interviewees were asked to provide medical care during interrogations so 

that the interrogations could be continued. No interviewees were aware of other 

medical personnel who were asked to do the same. 
(2) No interviewees reported either pre or post interrogation screenings were 

comoleted. 

c. Operation Iraqi Freedom 

(1) 1% (7 of 483) of interviewees were asked to provide medical care to detainees 

during interrogations so that the interrogations could be continued. These seven 

individuals represent seven different units, and each individual was requested to do so 

only once. 

(2) All seven reported administering the medical treatment that was required. 

Examples include (a) intravenous fluid administration for symptoms consistent with or 

for actual volume depletion and (b) providing food for hypoglycemia. One occurred at 

Camp Cropper in 2003 and one occurred at Abu Ghraib in 2003, while the other five 

occurred at short-term holding areas or collection points at various times. (See 

Interview #s 517, 698, 132, 661, 60, 250, and 505.) 

(3) Abu Ghraib 

(a) Prior to January 2004, very few pre- or post-interrogation screenings were 

completed at Abu Ghraib. In January 2004, the Air Force Detainee Health Team (DHT) 

was tasked to support military interrogation operations; the team consisted of one 

Family Medicine or Internal Medicine physician, one PA, and two medics. 

(b) The DHT provided initial medical assessments of detainees to determine 

preexisting conditions that might affect the interrogation process; it was also tasked with 

completing pre-, trans-, and post-interrogation medical assessments on an individual 

basis, at the request of the interrogators. These medical assessments were 

documented on a SF600 and included in detainee medical records. (See CONOPS for 

DHT in Support of Military Intelligence Interrogation Operations (Cit. 18).) 

(c) All interviewed DHT members denied ever being asked to provide medical care 

to detainees during interrogations so that the interrogations could continue. If medical 

care was needed for detainees during an interrogation, the interrogation was stopped, 

treatment was rendered, and the interrogation did not continue. (See lnterview # 734, 

788, 817.) 

(4) Camp Bucca. 12% (3 of 25) of interviewees reported that pre- and postinterrogation screenings were completed. Of these 3, 2 (8% of total) reported that 

screenings were documented and included in the medical records. 

(5) Camp Cropper. 49% (19 of 39) of interviewees reported that pre-interrogation 

screenings were completed. Of these 19, 17 (44% of total) reported screenings were 

documented, and of these 17 individuals, 9 (23% of total) reported documentation was 

included in the medical records. 10% (4 of 39) of interviewees reported that post- 
interrogation screenings were completed, documented, and included in the medical 

records. 

(6) Camp Liberty. 48% (19 of 40) of interviewees reported that pre-interrogation 

screenings were completed. Of these 19, 18 (45% of total) reported screenings were 

documented, and of these 18 individuals, 10 (25% of total) reported documentation was 

included in the medical records. 15% (6 of 40) of interviewees reported that postinterrogation screenings were completed, documented, and included in the medical 

records. 

(7) Mosul. 17% (1 of 6) of interviewees reported that pre-interrogation screenings 

were completed and documented; however, the individual was unsure if documentation 

was included in the detainee medical records. No interviewees reported that postinterrogation screenings were completed. 

(8) Tikrit. 14% (1 of 7) of interviewees reported that pre-interrogation screenings 

were completed, documented, and included in the detainee medical records. No 

interviewees reported that post-interrogation screenings were completed. 

11-3. Recommendations. DA guidance (DOD level is preferable) should: 

a. Authorize medical personnel to halt any interrogation or interrogation technique if 

the detainee's health or welfare is endangered. 

b. Require interrogations to stop immediately if a detainee requires any medical 

treatment during the interrogation. 

c. Authorize medical personnel to perform pre- and/or post-interrogation medical 

evaluations at their discretion. 

d. Require pre- and/or post- interrogation medical evaluations be performed upon the 

request of an interrogator. 

e. Require all pre-, during, and post-interrogation medical care to be documented 

and included in the detainee medical records. 

f. Describe the process for documenting medical care delivered during or due to an 

interrogation. 

g. Describe the process to report and document in the medical record suspected 

abuse. 

h. Require medical personnel to be trained on the above recommendations, with 

follow-up assessment of competency to measure the effectiveness of training. 
Chapter 12 

Question i. With respect to those detention facilities that kept medical records, 

did medical personnel properly generate, store and collect appropriate medical 

records of detainees? 

Section I 

General Findings 

12-1. General Findings 

a. Level Ill facilities consistently generated detainee medical records in the same 

manner as records for U.S. patients. 

b. The final disposition of original detainee medical records from level Ill facilities 

was usually the same as that of "retired" U.S. medical records (sent to PASBA). 

c. Within and among all interviewees from units providing level I and II medical care, 

there was extreme variability in method of documentation, circumstances influencing the 

creation of documentation, and the maintenance and final disposition of detainee 

medical records. 

d. In two separate instances, individuals reported reservations about writing their 

names on medical records that might eventually be given back to the detainee. One 

provider in OEF omitted his name entirely, and one provider in OIF intentionally 

changed the spelling of his last name. 

Section II 

Operation Enduring Freedom 

12-2. Findings 

a. The Team interviewed five PAD personnel (MOS 708, 70E, and 91G) from four 

h o ~ ~ i t a l s ~ h i 

provided or are currently providing level Ill detainee care in Bagram and Kandahar. All 

indicated that detainee medical records were generated and maintained in the same 

manner as records of U.S. patients in theater. The original medical records were 

initially maintained by PAD until the records were forwarded to PASBA for storage. 

b. lnterviewees from the'b"2'-2 reported copies of 

medical records were exclusivelv made to accomDanv detainees beincr transferred to 

another detention facility (e.g., GTMO). he'^"^)-'' - made no copies of detainee 

medical records. 

c. At Bagram, 85% (41 of 48) of interviewees reported unit procedures for controlling 

access to detainee medical records and 78% (36 of 46) reported unit procedures for 

c 
maintaining security of these records. None of 46 said that either "anyone" or 

interrogators could have access to these records. 

d. At Kandahar, 73% (1 1 of 15) of interviewees reported unit procedures for 

controlling access to detainee medical records and 75% (12 of 16) reported unit 

procedures for maintaining security of records. None of the 16 said "anyone" could 

have access to these records and only 6% (1 of 16) said interrogators could have 

access. 

Section Ill 

Guantanamo Bay Detention Facility 

12-3. Findings 

a. No specific PAD personnel were formally interviewed; however, during the site 

visit, the Team observed that detainee medical records were generated and maintained 

in the same manner as records of U.S. patients. The original medical records are 

maintained by PAD. 

b. All nine interviewees reported unit procedures for controlling access to detainee 

medical records and unit procedures for maintaining security of these records. One of 

nine (1 1 %) reported that "anyone" could have access to these records. (This individual 

then stated that no interrogators could have access.) 

Section IV 

Operation Iraqi Freedom 

12-4. Findings 

a. Abu Ghraib and Camp Cropper 

(1) The Team interviewed two PAD personnel (MOS 91 G and 70E) from two 

hospitalso(2)that provided or are currently providing level Ill 

detainee care at Abu Ghraib and Camp Cropper. Both reported that detainee medical 

records were generated and maintained in the same manner as records of U.S. patients 

in theater. The original medical records were initially maintained by PAD until the 

records were forwarded to PASBA for storage. 

(2) ~he'b"2'sent copies of discharge summaries to detention medical 

facilities. The -makes copies of detainee medical records only for CID, as 

needed for evidence in investigations. 

(3) At Abu Ghraib, 73% (107 of 147) of interviewees reported unit procedures for 

controlling access to detainee medical records, and 70% (103 of 147) reported unit 

procedures for maintaining security of these records. 6% (9 of 147) said "anyone" could 

have access to these records and 7% (10 of 147) said interrogators could have access. 
(4) At Camp Cropper, 69% (124 of 181) of interviewees reported unit procedures 

for controlling access to detainee medical records and unit procedures for maintaining 

security of these records. 6% (1 1 of 181) said "anyone" could have access to records 

and 7% (12 of 181) said interrogators could have access. 

b. Camp Bucca 

(1) The Team interviewed one 91G from the which is currently providing 

level Ill detainee care at Camp Bucca. He reported that detainee medical records are 

generated and maintained in the same manner as records of U.S. patients in theater. 

The original medical records are maintained by PAD initially and are then apparently 

provided to the detainee. Copies of detainee medical records are only made for CID as 

needed for evidence in investigations. 

(2) 63% (24 of 38) reported unit procedures for controlling access to detainee 

medical records and 58% (22 of 38) reported unit procedures for maintaining security of 

these records. 3% (1 of 38) said either "anyone" or interrogators could have access to 

these records. 

c. Camp Liberty 

(1) The Team interviewed three PAD personnel (MOS 91G and 70E) from two 

hospitals p)(2)-2 that provided or are currently providing level Ill care 

for detainees at the DIF at Camp Liberty. All indicated that detainee medical records 

were generated and maintained in the same manner as records of U.S. patients in 

theater. The original medical records in both facilities were initially maintained by PAD 

and then forwarded to PASBA. 

(2) heys sent copies of discharge summaries to the detention medical 

facility. T h e y makes copies of detainee medical records only for CID, as 

needed for evidence in investigations. 

(3) 65% (124 of 190 ) reported unit procedures for controlling access to detainee 

medical records and 66% (125 of 190) reported unit procedures for maintaining security 

of these records. 7% (1 2 of 190) said "anyone" could have access to these records and 

9% (1 6 of 190) said interrogators could have access. 

d. Mosul 

(1) The Team interviewed four PAD personnel (MOS 91 G and 70E) from two 

ho~~itals'~)(~)-~ 1 which provided level Ill care for detainees at the 

DIF in Mosul. All reported that detainee medical records were generated and 

maintained in the same manner as records for U.S. patients in theater. 
(2) At t h e y the original medical records were initially maintained by PAD 

and then forwarded to PASBA for storage. 

(3) ~he'b"2'records are being maintained by their PAD permanently. These 

records have not been forwarded to a repository. Copies of detainee medical records 

were sent to the detention medical facilities, to civilian hospitals, or other MTFs 

whenever detainees were transferred to one of these locations. 

(4) 78% (60 of 77) reported unit procedures for controlling access to detainee 

medical records and 77% (59 of 77) reported unit procedures for maintaining security of 

these records. 4% (3 of 77) said "anyone" or interrogators could have access to these 

records. 

e. Tikrit 

(1) The Team interviewed one 91G from thecb,m-2 which provided level Ill 

care for detainees at the DIF in Tikrit. He reported that detainee medical records were 

generated and maintained in the same manner as records of U.S. patients in theater. 

The original medical records were initially maintained by PAD and then forwarded to 

PASBA. Copies of detainee medical records were sent with detainees to the DIF upon 

discharge. 

(2) 79% (45 of 57) reported unit procedures for controlling access to detainee 

medical records and 81 % (46 of 57) reported unit procedures for maintaining security of 

these records. 5% (3 of 57) said "anyone" could have access to these records and 4% 

(2 of 57) said interrogators could have access. 

Section V 

General Discussion 

12-5. Methods of documentation for level I and II care include the following 

practices 

a. Completing an initial detainee medical evaluation on a Field Medical Card (FMC) 

(Department of Defense Form 1380 (DDI 380)) only, but then no subsequent 

documentation of any detainee care. 

b. Documenting detainee care in a log book for statistical purposes and unit reports. 

c. Documenting detainee care on Standard Form 600 (SF600) (Chronological 

Record of Medical Care) only for detainees with chronic medical conditions (with no 

documentation for others). 

d. Documenting all detainee care on SFGOO'S, but not documenting the initial 

screenings. 
e. Documenting initial screenings for all detainees on overprinted SFGOO'S. 

f. Documenting a complete history and physical examination on some or all 

detainees using the SF88 (Report of Medical Examination) and SF93 (Report of Medical 

History). 

12-6. Locations where original detainee medical documents were stored for 

level I and II care include the following: 

a. Detention facilities. 

b. Detention medical facilities. 

c. Medical unit treatment areas. 

d. Interrogation records maintained by MIIMP personnel. 

12-7. Copy machines. Copy machine availability was variable; therefore, when 

detainees were transferred to other detention facilities or medical facilities, they were 

accompanied by original medical records, copies of records, or sometimes no records at 

all. 

12-8. Access to and Security of Detainee Medical Records. The Team addressed 

access to and security of detainee medical records with several specific interview 

questions in addition to direct observations and questions during site visits to OEF, 

GTMO, and OIF. Individual responses to the pertinent questions were generally very 

consistent within each location, as well as across OEF, GTMO, and OIF. 

a. Security of records and confidentiality of medical information tended to be better at 

detention facilities that were co-located with medical facilities. Security and 

confidentiality also generally improved as an individual theater matured. 

b. When asked about which "other" personnel could have access to detainee 

medical records besides the treating medical personnel, the vast majority of answers 

were: PAD, CID, ICRC, and medical chain of command. A few individuals included 

MPs or other detention facility personnel. 

Section VI 

General Recommendations 

12-9. DA guidance (DoD level is preferable) should: 

a. Require that detainee medical records at facilities that deliver level Ill and higher 

care be generated in the same manner as records of U.S. patients in theater. 
b. Address the appropriate location and duration of maintenance as well as the final 

disposition of detainee medical records at facilities that deliver level Ill or higher care. 

c. Define appropriate generation, maintenance, storage, and final disposition of 

detainee medical records at units that deliver level I and II care. 

d. Address the need for uniform documentation, to include accurate identification of 

all individuals entering information into all detainee medical records. 

e. Clearly outline the rules for access to detainee medical records and provision of 

medical information to non-health care providers. The guidance should only permit 

release of detainee medical information to interrogators when needed to ensure the 

health and welfare of the detainee. 

12-10. Training of medical personnel. All medical personnel should be trained on 

the above and evaluated for competency. 

12-1 I. DA guidance (DoD level is preferable) should: 

a. Define who has access to detainee medical information and under what 

circumstances. 

b. Require that all military personnel are trained on this policy and evaluated for 

competency. 
Chapter 13 

Question j. With respect to those detention facilities that kept detainee medical 

records, identify the location where the original and any copies of the records are 

maintained. 

See Chapter 12 (Question i). 
Chapter 14 

Question k. Were any medical personnel aware of, or treat injuries related to, 

actual or suspected detainee abuse? 

14-1. General Findings 

a. Medical personnel were aware of, and treated injuries related to, actual and 

suspected detainee abuse. 

b. 5.0% (30 of 596) of past OEFIGTMOIOEF interviewees directly observed actual or 

suspected detainee abuse. 

c. 3.1% (2 of 64) of present OEFIGTMOIOIF interviewees directly observed actual or 

suspected detainee abuse. 

d. 5.4% (43 of 798) of past OEFIGTMOIOEF interviewees had a detainee directly 

report alleged abuse to them. 

e. 26.3% (20 of 76) of present OEFIGTMOIOIF interviewees had a detainee directly 

report alleged abuse to them. 

14-2. Findings - Operation Enduring Freedom 

a. No (0 of 60) past OEF interviewees directly observed actual or suspected 

detainee abuse. 

b. No (0 of 11) present OEF deployed interviewees directly observed actual or 

suspected detainee abuse. 

c. 1.6% (1 of 63) of past OEF interviewees had a detainee directly report alleged 

abuse to them. 

d. No (0 of 14) present OEF interviewees had a detainee directly report alleged 

abuse to them. 

14-3. Findings - Guantanamo Bay Detention Facility 

a. No (0 of 2) past GTMO lnterviewees directly observed actual or suspected 

detainee abuse. 

b. No (0 of 7) of present GTMO interviewees directly observed actual or suspected 

detainee abuse. 

c. No (0 of 2) of past GTMO interviewees had a detainee directly report alleged 

abuse to them. 
d. 28.6% (2 of 7) of present GTMO interviewees had a detainee directly report 

alleged abuse to them. 

14-4. Findings - Operation Iraqi Freedom 

a. 5.0% (30 of 596) of past OIF interviewees directly observed actual or suspected 

detainee abuse. 

b. 3.1% (2 of 64) of present OIF interviewees directly observed actual or suspected 

detainee abuse. 

c. 5.4% (42 of 733) of past OIF interviewees had a detainee directly report alleged 

abuse to them. 

d. 32.7% (18 of 55) of present OIF interviewees had a detainee directly report 

alleged abuse to them. 

14-5. General Discussion 

a. The above findings are based on responses to two questions: 

(1) Question 141 -Did any detainee report abuse directly to you? 

(2) Question 145 - Did you directly (or personally) observe detainee abuse? 

b. Medical personnel are often in a position to observe the physical evidence of 

actual or suspected abuse. Alleged abuse can also be revealed when obtaining a 

detainee's medical history. Not all acts of abuse are evidenced by physical injuries. 

c. Two important assumptions overlay the above findings. 

(1) Injuries potentially consistent with abuse can occur as a result of lawful combat 

operations (including the forcible capture of enemy combatants). 

(2) Lawful physical force is sometimes required to maintain good order and 

discipline in a detention setting. 

f. Acts of torture are clearly detainee abuse; however, other acts below the 

internationally recognized threshold of torture violate the standards of AR 190-8. The 

language of AR 190-8 sets a high standard of care and concern for all detainees: 

(1) Paragraph 1-5a(l): "All persons captured, detained, interned, or otherwise 

held in U.S. Armed Forces custody during the course of conflict will be given 

humanitarian care and treatment from the moment they fall into the hands of U.S. forces 

until final release or repatriation." 
(2) Paragraph 1-5a(2): "As a matter of policy, all detainees will be treated in 

accordance with the principles applicable to enemy prisoners of war unless and until a 

more precise legal status and accordant treatment is determined appropriate by 

competent authority." 

(3) Paragraph 1-5b: "The following acts are prohibited: murder, torture, corporal 

punishment, mutilation, the taking of hostages, sensory deprivation, collective 

punishments, execution without trial by proper authority, and all cruel and degrading 

treatment." 

(4) Paragraph 1-5c: "All persons will be respected as human beings. They will be 

protected against all acts of violence to include rape, forced prostitution, assault and 

theft, insults, public curiosity, bodily injury, and reprisals of any kind. This list is not 

exclusive. EPWIRP are to be protected from all threats or acts of violence." 

14-6. General Recommendations 

a. A DA definition of detainee abuse should be adopted (a DoD definition is 

preferable).' 

b. At all levels of professional training medical personnel should receive instruction 

on the definition of detainee abuse and the requirement to document and report actual 

or suspected detainee abuse. 

c. Pocket cards be developed and distributed to all deploying medical personnel with 

"Medical Rules of Engagement" on the front and a training aid on detainee abuse on the 

back.' 

1 The prohibitions of Paragraphs 1-5a through 1-5c of AR 190-8 should be considered when developing a 

definition for "detainee abuse." 2 Two suggested recommendations are below: 

The ABCs of Detainee Abuse Be a Medic 

A 

B 

Abuse is always wrong 

Be aware of the signs of abuse 

I

1 

1 

M 

E 

Medically asses all detainees 

Examine detainees for signs of abuse 

C 

1 Convey suspected abuse to your 

chain of command 1 

D Document your findings 

1 1 I Inform your chain of command of suspected abuse 
Chapter 15 

Question I. Did any medical personnel aware of, or who treated actual or 

suspected detainee abuse, properly document the abuse? 

15-1. Findings 

a. Although the majority of medical personnel aware of actual or suspected abuse 

reported the abuse to proper authorities, they did not consistently nor uniformly 

document such abuse in the medical record. 

b. The documentation of abuse in detainee medical records by medical personnel 

falls into three categories: 

(1) Medical personnel who routinely documented actual or suspected abuse and 

noted they had reported the abuse. 

(2) Medical personnel who routinely documented actual or suspected abuse but 

failed to note in the medical record if they had reported the abuse. 

(3) Medical personnel who failed to document actual or suspected abuse (medical 

evidence of abuse but no further notations in the medical record or lack of medical 

record). 

c. The Team discovered no DoD, Army, or theater policies requiring that actual or 

suspected abuse be documented in a detainee's medical records. 

15-2. Discussion 

a. Team members reviewed 463 detainee CSH medical records from OEF, GTMO, 

and OIF. Thirty-four (7.3%) of the reviewed records contained medical evidence of 

suspected abuse or notations of alleged abuse. Twenty-four of the 34 (70.6%) records 

do not state what action was taken concerning the suspected or alleged abuse. 

b. The first opportunity for medical personnel to document alleged or suspected 

abuse is often during a detainee's initial medical screening. There is no standardized 

detainee medical screening form.' The Team reviewed several field medical screening 

forms. All were different. 

c. Effective communication to subordinate units remains especially challenaina in a 

deployed theater. One example highlights this point. The ~ommander,l (b)(2)-2 


distributed AR 190-8 via e-mail to subordinate units. Some units providing detainee 

care reported never receiving this information. Many interviewees across the spectrum 

DA Form 4237-R (Detainee Personnel Record), found at page 81 in AR 190-8, contains one section 

(paragraph 44) entitled "Medical Record." The Team considers the required information in this section to 

be inadequate. 

15-1 

1 
of units the Team visited (including at least one Division Surgeon) were unaware of the 

medical guidance contained in AR 190-8. 

15-3. Recommendations 

a. A DA definition of detainee abuse be adopted (a DoD level definition is 

preferable). 

b. A DA standard requiring actual, alleged or suspected abuse be documented in a 

detainee's medical record (a DoD level standard is preferable). The standard should 

require: 

(1) Documentation of actual, alleged or suspected abuse in the detainee's medical 

record. 

(2) The medical provider's opinion if the medical evidence supports actual, alleged 

or suspected abuse; and 

(3) The action taken by medical personnel: 

(a) If the medical evidence fails to support the alleged abuse this fact should be 

noted in the detainee's medical record. 

(b) If the medical evidence is consistent with abuse, or is inconclusive, medical 

personnel must report the alleged or suspected abuse to the hospitalIMTF commander 

(MEDCOM SJA Information Paper - Health Care Professional Detainee Abuse 

Reporting Requirements - 8 Sep 04) (Cit. 31). 

(c) A notation in the detainee's medical record that a report was made, when, and 

to whom. 

c. A DA standard detainee medical screening form should be developed and fielded 

(a DoD level standard is preferable). 
Chapter 16 

Question m. To whom did any medical personnel aware of, or who treated, 

detainee abuse report such abuse? 

16-1. General Findings 

a. Medical personnel aggressively reported actual and suspected detainee abuse to 

the proper authorities.' 

b. Medical personnel typically reported actual or suspected detainee abuse to one 

(or more) of three channels: 

(1) Medical supervisor. 

(2) Chain of command 

(3) Criminal investigators (CID) 

c. 73 previous1 deployed medical personnel were personally aware of actual or 

suspected abuseY 87.6% (64 of 73) reported the actual or suspected abuse3 

d. 22 presently deployed medical personnel were personally aware of actual or 

suspected abuse.4 100% (22 of 22) reported the actual or suspected abuse. 

e. Only 2 interviewees failed to properly report actual or suspected detainee abuse 

which had not otherwise been conveyed to an appropriate authority.5 

16-2. Findings - Operation Enduring Freedom 

a. 1 previously deployed OEF medical provider was personally aware of actual or 

suspected abuse. This provider reported the actual or suspected abuse. 

1 An incident of abuse may have been observed andlor reported by more than one interviewee. 2 5.4% (43 of 798) of past OEFIGTMOIOIF interviewees responded "yes" to question 141 (Did any 

detainees report abuse directly to you?). 5.0% (30 of 596) of past OEFIGTMOIOIF interviewees 

responded "yes" to question 145 (Did you directly observe possible abuse?). 

3 There were 4 "no report made" answers to question 142 by previously deployed personnel. One was 

not reported for lack of specific information (Interview 140). Three were deemed to lack credibility 

(Interviews 415, 454 and 945). There were 5 "no report made" responses to question 146. In three 

cases the interviewees reported action was taken (Interviews 465, 717 and 729). 

26.3% (20 of 76) of present OEFIGTMOIOIF interviewees responded "yes" to question 141 (Did any 

detainees report abuse directly to you?). 3.1% (2 of 64) of present OEFIGTMOIOIF interviewees 

responded "yes" to question 145 (Did you directly observe possible abuse?). 5 
The Team referred one of these cases to CID (Interview 72) and one to the chain of command after 

conferring with the CID Staff Judge Advocate (Interview 33). One additional case, in which previous 

administrative action was taken, was also referred by the Team to CID (See Chapter 20, Incident and 

Allegations Table #72). 
b. No presently deployed OEF medical personnel stated they were personally aware 

of actual or suspected abuse. 

16-3. Findings - Guantanamo Bay Detention Facility 

a. No previously deployed GTMO medical personnel were personally aware of actual 

or suspected abuse. 

b. 2 presently deployed GTMO medical personnel were personally aware of actual or 

suspected abuse. Both stated they reported the actual or suspected abuse. 

16-4. Findings - Operation Iraqi Freedom 

a. 72 previously deployed OIF medical personnel were personally aware of actual or 

suspected abuse. 85.5% (63 of 72) reported the actual or suspected abuse (See 

footnote #3). 

b. 18 presently deployed OIF medical personnel were personally aware of actual or 

suspected abuse. 100% (18 of 18) reported the actual or suspected abuse. 

16-5. General Discussion 

a. Recent media articles have focused on the alleged torture and abuse of detainees 

by U.S. military members. DoD guidance clearly requires reporting alleged or 

suspected tort~re.~ 

b. Present MEDCOM guidance requires medical personnel to report detainee 

abuse.7 

c. The above findings are based on responses to four questions: 

(1) Question 141: Did any detainee report abuse directly to you? 

(2) Question 142: (If yes) Did you report this? 

(3) Question 145: Did you directly (or personally) observe detainee abuse? 

(4) Question 146: (If yes) Did you report this? 

d. By any measure, medical personnel were exceptionally vigilant in reporting actual 

or suspected detainee abuse. It is especially encouraging that all observed or reported 

suspicion of detainee abuse was reported by presently deployed medical personnel. 

ti 
 Paragraph 4b, CJCSl 3290.01A, 15 October 2000, Program for Enemy Prisoners of War, Retained 

Personnel, Civilian Internees, and Other Detained Personnel (EPWiDetainee Policy) (Cit. 16). 

Paragraphs 4.3 and 4.4, DoD Dir. 5100.77, DoD Law of War Program (9 December 1998) (Cit. 23). 

Health Care Professional Detainee Abuse Reporting Requirements. dated 8 September 2004 (Cit. 31). 
16-6. General Recommendations 

a. At all levels of professional training, medical personnel should receive instruction 

on the requirement to document and report actual or suspected detainee abuse. This 

training should include the definition and signs of actual or suspected detainee abuse. 

b. Scenario-based training on detecting detainee abuse should be developed and 

fielded at all PPPs, MUICs, and reserve medical training sites. All deploying medical 

personnel should receive this training prior to arrival in theater. 

c. All deploying medical personnel, prior to arrival in theater, should receive refresher 

training on the requirements and procedures to document and report actual or 

suspected detainee abuse. 

d. All individual and collective training for medical personnel (such as NTC, JRTC, 

Warfighters, and field training exercises (FTXs)) should include reinforcing training on 

recognizing and reporting actual or suspected detainee abuse. 

e. Follow-on competency evaluations should be incorporated into all training 

guidance and plans. 
Chapter 17 

Question n. Were there any theater or unit policies or established SOPsITTPs 

that specifically required medical personnel to report detainee abuse? 

17-1. General Findings 

a. Theater level guidance specifically requiring medical personnel to report detainee 

abuse was implemented within the past year. 

b. Unit policies and SOPsITTPs were sometimes absent andlor not properly 

disseminated to deployed medical personnel. 

c. Medical personnel with knowledge of existing unit policies/SOPs/TTPs 

overwhelmingly complied with such guidance. 

(1) 37.0% (295 of 798) of formerly deployed OEFIGTMOIOIF interviewees were 

aware of a unit requirement to report suspected detainee abuse. 94.2% (278 of 295) of 

these interviewees reported their unit followed the policies. 

(2) 85.5% (65 of 76) of presently deployed OEFIGTMOIOIF interviewees were 

aware of such policies. 98.5% (64 of 65) of these interviewees reported their unit 

followed the ~olicies. 

d. The awareness of unit level policies requiring reports of detainee abuse has 

steadily increased. 

17-2. Findings - Operation Enduring Freedom 

a. The Team did not discover a theater level policy specifically requiring medical 

personnel to report detainee abuse.' 

b. 39.7% (25 of 63) of formerly deployed OEF interviewees were aware of a unit 

requirement to report suspected detainee abuse. 88% (22 of 25) of these interviewees 

reported their unit followed the policies. 

c. 71.4% (1 0 of 14) of presently deployed OEF interviewees were aware of such 

policies. All ten reported their unit followed the policies. 

There is presently a theater specific requirement to report alleged or suspected detainee abuse to the 

chain of command. CJTF-76, Detainee Operations SOP (S), paragraph 5b (U), dated 21 January 2005. 

17-1 


1 
17-3. Findings - Guantanamo Bay Detention Facility 

a. The earliest discovered theater policy specifically requiring medical personnel to 

report detainee abuse is dated 9 August 2004.~ 

b. 100% (2 of 2) of formerly assigned GTMO interviewees were aware of such 

policies. Both reported their unit followed the policies. 

c. 71.4% (5 of 7) of presently assigned GTMO interviewees were aware of such 

policies. All five reported their unit followed the policies. 

17-4. Findings - Operation Iraqi Freedom 

report detainee abuse is dated 12 July 2004. 

a. The earliest discovered theater policy s Pecifically requiring medical personnel to 

The medical unit presently responsible 

for Abu Ghraib, "(2)-2 1 has also published a 

requirement to report alleged or suspected detainee abuse.4 

b. The OIF Theater Detention Healthcare Policy, paragraph 3B, dated January 2005 

(Cit. 37), requires medical personnel to be trained to recognize the signs and symptoms 

of detainee maltreatment and abuse and to report any reported or suspected abuse.5 

c. The Team did not discover a theater policy specifically requiring medical 

personnel to report detainee abuse.6 

d. 34.7% (268 of 773) of formerly deployed OIF interviewees were aware of a unit 

requirement to report suspected detainee abuse. 94.8% (254 of 268) of these 

interviewees reported their unit followed the policies. 

e. 90.9% (50 of 55) of presently deployed OIF interviewees were aware of such 

policies. 98% (49 of 50) reported their unit followed the policies. 

2 
 USSOUTHCOM Policy on Health Care Delivery to Enemy Persons Under U.S. Control at US Naval 

Base Guantanamo Bay, Cuba, 9 August 2004. Paragraph 10a states "Medical personnel who gain 

knowledge of physical or mental ill-treatment of detainees will report this ill-treatment to the appropriate 

military authority." (Cit. 43). 3 FRAGO 329, Detention Operations to MNC-I OPORD 04-01 (S), 12 July 2004, Annex C (unnumbered 

paragraph), Medical Authority Responsibilities (U), states (original bolded) "Any sign of mistreatment 

will be reported to the Commanding General." 4 Paragraph 5 of The Tenets of Detention Healthcare, dated March 2005 (Cit. 45), states "All allegations 

or possible signslsymptoms of abuse, torture or maltreatment must be immediately reported to CID and 

the Detention Ops and medical chains of command regardless of whom or when it occurred." 

5 This paragraph also states "Healthcare providers must be trained in the tenets of the Geneva 

Conventions, the law of war, standards of medical care, AR 190-8, and other regulations and principles of 

detainee care." This policy does not identify when the required training should occur, nor who is 

responsible to provide the training. The policy also does not define what personnel are considered to be 

"healthcare providers." ' There is presently a theater specific requirement to report alleged or suspected detainee abuse to the 

chain of command. CJTF-76, Detainee Operations SOP (S), paragraph 5b (U), dated 21 January 2005. 
17-5. General Discussion 

a. Many unit policies were verbally briefed to personnel but never formalized in 

writing. 

b. Commanders and leaders at all levels should present a unified position that 

detainee abuse is wrong, and that alleged or suspected abuse must be promptly 

documented, reported, and properly investigated. 

c. Despite the small GTMO interview sample, the Team is confident the results are 

accurate. Policies governing detainee procedures at GTMO were extensive, and based 

on the Team's personal observations, strictly adhered to. 

d. Carefully planned post-training competency assessments are critical to ensure 

training is effectively equipping medical personnel to successfully recognize, document, 

and report actual or suspected detainee abuse. 

17-6. General Recommendations 

a. Clearly written standardized policies for documenting and reporting actual or 

suspected detainee abuse should exist at all levels of command (DoD, Army, 

Combatant Command, theater, and individual subordinate units). These policies must 

then receive command emphasis on a continuing basis. 

b. Medical planners at all levels should ensure clearly written standardized guidance 

is provided to medical personnel. This guidance should list possible indicators of abuse 

and contain concise instruction on how, and to whom medical personnel should 

document and report actual or suspected abuse. 

c. Develop DA level guidance (DoD level is preferable) on the procedures for 

processing allegations of abuse not supported by medical evidence. This guidance 

should contain clear instructions on how medical personnel should properly document 

allegations of abuse that are not further reported based on lack of medical evidence. 
Chapter 18 

Other Issues 

Section I 

Overview of Site Visits to Afghanistan (OEF), Cuba (GTMO), and Iraq (OIF) 

18-1. Operation Enduring Freedom 

a. The overall level of outpatient and inpatient detainee medical care is extremely 

high. 

b. Living conditions are very good and detainees are treated respectfully. 

c. During a walk-through of t h e y the Team reviewed 

the care of a detainee in the Intermediate Care Ward (ICW). Some entries in his record 

were not signed by an attending physician. Although this was apparently not a common 

practice at the hospital, others were also hesitant to put their names on entries, as these 

documents might eventually be given to detainees upon their release from the facility. 

d. The BagramIKandahar (BHAIKHA) SOP, dated 8 March 2005 (S), states that 

medical records will be destroyed after three years from the time of any detainee's 

release. This does not specifically follow the provisions of AR 40-400, paragraphs 15-2 

and 15-8, which require fixed and deployed MTFs to transmitlprovide PASBA with the 

medical records and workload reports. Additionally, PASBA has been designated the 

interim inpatient record holdinglprocessing facility for records from the deployed level Ill 

MTFs, memorandum dated 12 Mar 2004, unsigned (Cit. 32). 

e. Policies and procedures were often hard to obtain prior to a unit's arrival in 

theater. Mobilizing units should have access to these well in advance of arrival. 

f. Medical care and initial screening procedures at BHA were streamlined and weilconceived. 

18-2. Guantanamo Bay Detention Facility 

a. The overall level of outpatient and inpatient detainee medical care is extremely 

high. Staff has the ability to utilize four beds at the Naval Hospital for detainees as well, 

which can include Intensive Care Unit (ICU) care. According to the Hospital's 

Commander the GTMO Naval Hospital recently received full Joint Commission 

Accreditation for Healthcare Organizations (JCAHO) with no findings. 

b. Detainee medical records are extremely complete, and mirror U.S. medical 

records. Outpatient records examined had complete master problem lists. Inpatient 

discharge summaries are also translated into native languages for those patients being 

sent home. 
c. Detainee living conditions overall appeared very good. 

d. All interrogations are videotaped. Medics randomly observe interrogations and 

have the ability to halt an interrogation at any point they deem necessary. 

18-3. Operation Iraqi Freedom 

a. T a n d Camp Bucca 

(1) Overall the level of medical care was felt to be exceptional. 

(2) Entire staff takes responsibilities seriously; mottos include: "Restoring 

America's Honor," and "Detention Healthcare is a Globally Visible, Strategic-level 

Mission." 

(3) Initial intake assessments are very comprehensive and are appropriately 

recorded. This includes history and physical, dental, nutritional, chest x-ray, 

immunizations, and retinal scanning. Master problem lists are very complete. 

Comprehensive care is also available for more complicated chronic diseases, including 

a multi-disciplinary team for diabetic patients, prosthesis clinic with physical 

therapy/occupational therapy, and 24 hour in-patient and out-patient psychiatric care. 

(4) Daily sick call is well-organized (average up to 10% of the population on any 

given day) and ranges from on-site in the camp to the emergency room. 

(5) Records security is excellent. The staff is well-versed on keeping medical 

information separate from MI personnel. 

(6) Living conditions appeared very good; all detainees were treated respectfully. 

Detainee rights and patient rights are clearly posted. All staff are directed to report even 

minimally-suspected abuses. 

(7) BSCT staff is appropriately utilized with carefully-defined roles. They do not 

provide any clinical care. 

(8) There is comprehensive development of policies and medical forms, with 

generally widespread dissemination and education of all staff. Hospital committees are 

well-organized, including: executive, credentials, pharmacy and therapeutics, and 

bioethics. 

(9) Strong recommendations from the staff to the Team were to widen detention 

medical training, e.g., incorporate at JRTC, etc. 

b. DIF Visits at Tikrit and Baghdad 
(1) Medical documentation very good; detainees remain at these locations 

generally days-to-weeks. 

(2) Initial intakes are less comprehensive, but still good, and are documented in 

records. 

(3) Some medics were not well-versed in their understanding of the separation of 

medical information from MI staff, and it was not clear that access to medical 

information was as secure as possible. 

(4) Some translators used during medical intakes and other clinic visits were also 

used by MI staff during interrogations, also representing a potential breech in security of 

medical information. The Team discussed this on-site with the staff, as well as with the 

Fb)(2)-2 Commander as a suggested area for improvement. 

(5) Shortages of translators existed for a variety of reasons, including: a lack of 

qualified personnel who have been cleared to work for Coalition Forces, others would 

terminate their services because of potential danger to themselves from insurgents, and 

priority often went to interrogation staffing needs. 

(6) There were some concerns over the staffing at the DIFs. Medical assets, in 

particular 91 Ws, were provided no flexibility when assigned to these areas. A loss of 

one person, for any reason, could hamper their ability to provide adequate care. 

18-4. Recommendations 

a. CFLCC guidance, regulations, and standards in relation to detainee healthcare, to 

OEF and OIF theaters, should be standard across the AOR, consistent with DoD 

guidance, and disseminated to the lowest levels. 

b. Prior to the onset of operations, combat or humanitarian, dedicated translators 

must be embedded within level Ill healthcare units, for use by medical assets only. 

c. OIF medical commanders should ensure medical assets are in place, and have a 

viable system to replenish them when necessary, at level I or II facilities that have 

significant detainee contact. 

d. To ensure that medical information is protected, translators assisting medical 

personnel with detainee care should not assist interrogators who question the same 

detainees. 

Section II 

OIF Theater Preparation for Detainee Medical Care 

18-5. Findings 
a. In planning for detainee medical operations there were limited assets allocated to 

provide support for detaineelEPW medical care. The plan did not encompass medical 

assets to provide chronic care, definitive care, or rehabilitative care in theater. (FRAGO 

1206 to CJTF-7 OPORD 03-036 (Secret) and FRAGO 20 to FORSCOM Deployment 

Orders in Support of OIF-2 (Secret).) 

b. There was a reauirement to deliver medical care to detainees in theater, 

c. Level I, II, and Ill medical assets were not resourced to deliver the special needs 

presented by this population. 

18-6. Discussion 

a. Planning ITransfer l Evacuation 

(1) Theater medical asset needs were planned using an expected patient 

population of injured military and non-hostile civilians. 

(2) The robust system for medical evacuation allowed military patients to receive 

treatment at Landstuhl Regional Medical Center (LRMC) and, if needed, in CONUS in a 

very rapid fashion. In many cases the time from injury to arrival at LRMC was as short 

as 36 hours. 

(3) For injured non-hostile civilians, transfer to lraqi civilian medical treatment 

facilities was limited by the level of care available at those facilities (but not by security 

and intelligence requirements). 

(4) Transfer of detainees out of theater, or to other than U.S. military treatment 

facilities, was not possible due to international agreements and security and intelligence 

reasons. 

b. Issues Identified with Detainee Care 

(1) lraqi civilian and detainee populations have special care needs that are not 

commonly found in our deployed Soldier population; for example, obstetrics, pediatric 

and neonatal intensive care, dialysis, airborne communicable diseases, and complex 

chronic medical conditions. Level Ill MTFs are not routinely equipped with the 

personnel, supplies, infrastructure, or medications required to properly care for patients 

with such conditions. 

(2) lnterviewees reported shortfalls in a number of areas. Some examples are 

listed below. 

(a) Capacity. The extended stays in level II holding areas, combined with 

prolonged hospital stays of the detainee population, resulted in limited availability of 

beds and constrained surge capability. 
i. lnterviewees reported that detainees with external fixators needed to remain in a 

level Ill MTF ICW until the external fixator was no longer required, resulting in a need to 

expand the inpatient bed capability. 

ii. Definitive and rehabilitative burn care requires extremely long hospitalization 

when burn center transfer is not available. 

(b) Medications. Units providing level I and II medical care didn't routinely stock 

medications needed to treat chronic medical and psychiatric problems. 

i. Anti-hypertensive, cardiac, anti-tuberculous, anti-psychotic, and anti-depressive 

medications were not part of the authorized packing list in a MP company or battalion 

medical section. 

ii. Long-acting insulins were not part of the medical equipment sets (MES) packing 

list for medical companies in a maneuver unit. 

.. . 

III. Oxygen (or oxygen concentrating equipment) was not available in sufficient 

quantity to provide continuous oxygen therapy to detainees that were held for prolonged 

times in medical company holding areas or aid stations. 

c. Facility Infrastructure 

(1) Negative pressure isolation was not available for holding patients with 

contagious illnesses. 

(2) Level Ill facilities housed detainees in a variety of ways that impacted the 

location of medical and security resources. Detainees required both ICU- and ICWlevel care within a hospital; these separate wards required two different sets of security 

resources. 

d. Medical Supplies and Equipment 

(1) Level Ill facilities did not initially stock pedicle screws for spine surgery. The 

inability to conduct definitive spine surgery increased the hospital length of stay as 

patients with spinal injuries faced complicated healing and rehabilitative requirements. 

(2) MP medics were not supplied with glucometers. 

(3) Medical companies stocked a limited supply of glucose test strips and 

glucometers. These supplies were insufficient to adequately monitor multiple patients 

for months at a time. 

(4) Initially Level Ill facilities did not have the required plates and screws to 

definitively treat maxillofacial injuries. 
e. Mental Health and Psychiatric Care Resources 

(1) This is a broad ranging area that includes suboptimal resourcing at all levels of 

care. Shortfalls existed in medications, isolation capabilities (infrastructure), psychiatric 

expertise (anti-psychotic and anti-depressive medication management), and counseling 

expertise (both the mental health professional and the necessary interpreter). 

(2) The detainee population became a hotbed for mental health and psychiatric 

care needs for several reasons: 

(a) Individuals were often taken into custody without their personal medication 

supply. 

(b) Mood disorders are often exacerbated in a detention environment. 

18-7. Recommendations. 

a. The AMEDD should establish an experienced SME team to: 

(1) Comprehensively define the personnel, equipment and supply needs for 

detainee operations. 

(2) Develop a method to ensure a flexible delivery system for these special 

resources to the appropriate levels of care and for the entire timeline of future military 

operations. 

b. Military planners need to assume that there is a high likelihood for detainee 

operations in all future conflicts and must allocate resources for detainee medical care 

in the planning process. 

Section Ill 

Medical Screening and Sick Call at the DlFs and Prisons 

18-8. Findings 

a. Detainees have had excellent access to daily sick call, outpatient, and inpatient 

medical care. 

b. The vast majority of interviewees reported that initial screening medical 

examinations were performed during in-processing to a DIF or prison. 

18-9. Discussion 

a. Operation Enduring Freedom 
(1) Bagram 

(a) 71% (5 of 7) interviewees reported that detainees receive initial screening 

medical examinations. Two interviewees were uncertain (they did not work in the 

detainee intake area). 

(b) All interviewees reported detainee access to daily sick call. 

(c) The Team visited Bagram in March 2005. Detainees receive initial screening 

medical examinations, have access to daily sick call, and 24 hours access to an on-call 

medic. 

(2) Kandahar 

(a) All interviewees (10) reported that medical personnel completed initial 

screening medical examinations on detainees. 

(b) 90% (9 of 10) interviewees reported detainee access to daily sick call. One 

interviewee, deployed in theater between August 2003 and May 2004, reported that 

detainee sick call was not available. 

(c) The Team reviewed the KHA SOP (Cit. 17). The SOP requires that all 

detainees receive an initial screening examination, have access to daily sick call, and 

24 hour access to an on-call medic. 

b. GTMO. The Team visited GTMO in January 2005. Detainees receive initial 

screening medical examinations, have access to daily sick call, and 24 hour access to 

an on-call medic. 

c. Operation Iraqi Freedom 

(1) Abu Ghraib 

(a) 95% (42 of 44) interviewees reported that detainees receive initial screening 

medical examinations. Two interviewees were uncertain (they did not work in the 

detainee intake area). 

(b) All interviewees reported detainee access to daily sick call. 

(c) The Team visited Abu Ghraib in March 2005. Detainees receive initial 

screening medical examinations, have access to daily sick call, and 24 hour access to 

an on-call medic. 

(2) Camp Bucca 
(a) 76% (16 of 21) interviewees reported that detainees receive initial screening 

medical examinations. One interviewee, deployed in theater from April 2003 to April 

2004, stated detainees did not receive initial medical screenings. Four interviewees 

were uncertain (they did not work in the detainee intake area). 

(b) All interviewees reported detainee access to daily sick call. 

(c) The Team visited Camp Bucca in March 2005. Detainees receive initial 

screening examinations, have access to daily sick call, and access to an on-call medic 

continuously. 

(3) Camp Cropper 

(a) 86% (31 of 36) interviewees reported that detainees receive initial screening 

medical examinations. One interviewee, deployed in theater from April 2003 to April 

2004, stated detainees did not receive initial medical screenings. Four interviewees 

were uncertain (they did not work in the detainee intake area). 

(b) All but one interviewee reported that detainees had access to daily sick call. 

One medic, deployed in theater between April 2003 and April 2004, reported that sick 

call was not available. 

(4) Camp Liberty 

(a) 97% (34 of 35) interviewees reported that detainees receive initial screening 

medical examinations. One interviewee was uncertain (he did not work in the detainee 

intake area). 

(b) 94% (33 of 35) interviewees reported detainee access to daily sick call. One 

interviewee, deployed in theater between February 2003 and February 2004, stated sick 

call was not available, one interviewee was uncertain. 

(c) The Team visited Camp Liberty in March 2005. Detainees receive initial 

screening medical examinations, have access to daily sick call, and 24 hour access to 

an on-call medic. 

(5) Mosul 

(a) 88% (7 of 8) interviewees reported detainees receive initial screening medical 

examinations. The other interviewee was uncertain. 

(b) 88% (7 of 8) interviewees reported detainees had access to daily sick call. 

One interviewee, who was in theater between February 2003 and June 2003, reported 

that sick call was not available. It is unclear what dates he worked at the detention 

facility itself. 
(6) Tikrit 

(a) All five interviewees reported that detainees receive initial screening medical 

examinations. Detainees presently have access to daily sick call. 

(b) The Team visited the facility in Tikrit in March 2005. Detainees receive initial 

screening examinations, have access to daily sick call, and 24 hour access to an on-call 

medic. 

18-10. Recommendations 

a. DA guidance (DoD level is preferable) should require: 

(1) Initial medical screening examinations upon inprocessing to a detention facility. 

(2) Daily access to medical care for all detainees. 

b. All military personnel must be trained on the above policy and demonstrate 

competency. 

Section IV 

Restraintslsecurity 

18-1 1. Findings 

a. The use of physical restraints for detainees varied widely within and among all 

interviewed units. 

b. The Team found no evidence that medical personnel used medications to restrain 

detainees. 

c. lnterviewees reported medical personnel were tasked to perform a variety of 

detainee security roles. 

d. Medical documentation of restraint was neither uniform nor consistent. 

18-12. Discussion 

a. The Team found little consistency in the use of restraints for detainees. Some 

medical units used restraints on all detainees for security reasons, some used them 

only when detainees were violent or disruptive, and others, specifically level Ill facilities, 

used them only for medical indications such as attempts to dislodge medical devices, or 

for risk of falling. 

b. The following factors influenced the decision to restrain detainees 
(1) The availability of MPs. 

(2) The availability of unit medical staff for security purposes. 

(3) Unit policies and directives. 

c. lnterviewees expressed concern about tasking of medical personnel for detainee 

security purposes. The rationale for the concern was the ethical conflict of both caring 

for and guarding detainees. Additionally, as medical personnel were tasked to provide 

security support, it impacted on the ability of the unit to provide care to all patients, 

including U.S. Soldiers. 

d. 28% (196 of 728) interviewees reported good or excellent medical documentation 

related to the use of restraints. The Team found that many medical personnel may not 

have viewed this as a high priority. Detainee inpatient documentation on the use of 

restraints was not consistent with restraint documentation standards found in most U.S. 

hospitals. 

18-13. Recommendations 

a. DA guidance (DoD level is preferable) should standardize the use of restraints for 

detainees in units delivering medical care. The guidance should contain clear rules for 

security-based restraint versus medically-based restraint. Medical personnel must be 

trained on this guidance, with follow-up competency evaluations. 

b. Use of restraints on any patient should be appropriately documented in the 

medical record. 

c. All facilities providing level II or Ill care should be appropriately supplemented with 

MPs dedicated to provide detainee security. 

Section V 

Medical Personnel Photographing Detainees 

18-14. Findings 

a. There are inconsistencies among ARs, individual unit guidance, and usual medical 

practices regarding photographing detainees. 

b. Many medical personnel photographed detainees for a variety of reasons, 

including: medical documentation, future teaching material, possible criminal 

investigation documentation, and future identification for detainee family members, 

18-1 5. Discussion 
a. Of the 520 individuals asked, 73% (379 ) said photographs of detainees were 

taken in their units with either a personal or unit-owned camera. When pictures were 

used for documentation, they were included in the detainee medical record(s), included 

in an investigation record, or obtained post-mortem for future identification, i.e., when no 

family members were available at the time of death. More often, pictures were taken by 

medical personnel for their future teaching material, or for unit case logs. Of the 379 

that reported detainees being photographed, 42% (1 59) reported that these included 

faces. Of these 159, 32% (51) explained this was only in the case of facial injuries or 

other medical findings involving the face. Of the 159, 7% (1 1) explained this was only 

with permission by the detainee to include the face, and 3% (4) explained this was for 

the post-mortem or investigation documentation described above. 

b. Many of the individuals who reported that pictures were not taken of detainees 

explained that this was specified (i.e., not allowed) in either a unit policy or an AR. 

c. A few individuals reported personal concern that the use of photography in their 

unit made them uncomfortable, even when it was done as part of medical 

documentation or future personal teaching material. One individual reported that when 

she made these concerns known to other members of her unit, she was socially isolated 

from her co-workers (Interview # 543). 

d. While AR 190-8, paragraph 1-5d, strictly prohibits photographing EPWs, RPs and 

CIS "for other than internal internment facility administration or intelligence1 

counterintelligence purposes," the 2004 edition of the Emergency War Surgery text 

(Chapter 34) advocates units having a digital or other high quality camera for use in 

medical documentation of EPW injuries. This text also advocates the inclusion of faces 

in these pictures for accurate, efficient, and complete documentation of patient injuries 

and surgical interventions. In addition, AR 40-66 (which is not specific to detainees), 

paragraph 3-1 b, allows photographs to be "mounted on authorized forms and filed in 

medical and dental records." Paragraph 2-8b(8)(b) further requires that consent must 

be obtained to release photographs "of a person or of any exterior portion of his or her 

body" for the purpose of research. 

18-16. Recommendations 

a. DA guidance (DoD level is preferable) should: 

(1) Authorize photographing detainee patients for the exclusive purpose of 

including these photos in medical records, and not require informed consent for 

photographs used in this manner (consistent with AR 40-66). 

(2) Mandate that photographs of detainees taken by medical personnel for other 

reasons, including future personal education material, research, or unit logs, must first 

have informed consent from the detainee. 
b. Guidance for the above should be included in AR 190-8, which is currently under 

revision. 

Section VI 

The Use of Behavioral Science Consultation Teams (BSCT) in the lnterrogation 

Process 

18-17. General Findings 

a. BSCT personnel are not serving in a health care provider role. 

b. There is no indication that BSCT personnel participated in abusive interrogation 

practices. 

c. BSCT personnel presently do not have access to detainee medical records, 

d. The BSCTs provide forensic psychological expertise to ensure the interrogation 

process is conducted in a safe, legal and ethical manner. 

18-18. Findings - Operation Enduring Freedom 

There was no use of BSCTs in Afghanistan; however, the Team was informed that a 

BSCT was in route to support interrogation activities. 

18-19. Findings - Guantanamo Bay Detention Facility 

a. The Team interviewed seven AC psychiatrists, psychologists, and a behavioral 

science technician providing direct support to the Joint lnterrogation Group (JIG) at 

GTMO (three presently serving and four served previously at GTMO). They were 

assigned to CSCs with duty at GTMO. 

b. There is no doctrine or policy that defines the role of behavioral science personnel 

in support of interrogation activities; however, there are SOPS which describe the role 

and responsibilities of personnel serving in a BSCT role (Cit. 13). The rating chains for 

these personnel were not in medical channels. BSCT personnel are rated by the JIG 

Commander and senior rated by the Commanding General or Chief of Staff of the Joint 

Task Force (JTF) GTMO. 

c. Personnel serving in a BSCT role at GTMO provided behavioral science 

consultation to the JIG and JTF command group. Physicians/psychiatrists and 

psychologists were initially assigned to this duty in 2002. Since mid year 2003, the 

positions have been filled by psychologists. The duties of the BSCT include: 

(1) Reviewing detainee information. 

(2) Providing opinion on character and personality of detainee, 
(3) Assessing how dangerous a detainee might be (ref. release and potential 

future combat role). 

(4) Providing opinion on behavioral science aspects of the camp and camp 

organization and procedures. 

(5) Consulting on interrogation plan and approach. 

(6) Providing feedback on interrogation technique. 

(7) Teaching behavioral science topics to interrogators, 

d. The BSCT personnel observed interrogations but were not active participants in 

the interrogation process. 

e. The BSCT personnel were not medically credentialed at GTMO and did not 

provide any medical services in the medical treatment facility. Several BSCT personnel 

did have access to the detainee medical records. In June 2004, BSCT were no longer 

permitted to directly review detainee medical records. The BSCT personnel did not 

document the medical condition of detainees in the medical record but did keep a 

restricted database which provided medical information on detainees. BSCT personnel 

never provided psychological services for detainees but on two occasions consulted 

with interrogators who were experiencing non-work related stress. 

f. Two of the seven personnel interviewed did feel conflicted while serving in the 

BSCT role. The conflict centered on the lack of SOPs, policy and guidance on how to 

function in this role. In both instances, the conflict was resolved through refinement of 

procedures and establishment of SOPs. Every interviewee felt that medical personnel 

should serve in a BSCT position for interrogation activities, but recommended using 

psychologists, not physicians/psychiatrists, in this role. 

g. In the realm of training, all BSCT personnel were familiar with the Geneva 

Conventions but only four out of seven felt their training prepared them for addressing 

the human rights issues of detainees. The psychologists did go through limited training 

at Fort Bragg Resistance Training Laboratory prior to taking on the BSCT role at GTMO. 

h. There was one incidence where a BSCT member was aware of potential abuse as 

he was present when the Federal Bureau of Investigation (FBI) reported the incident to 

the JIG Commander. Apparently the abuse involved an interrogator pulling on the 

thumbs of a detainee. Another BSCT member reported a questionable incident where a 

female interrogator took off her battle-dress uniform (BDU) jacket, rubbed her breasts 

against the body of the detainee being interrogated, sat on his lap and whispered in his 

ear. The interrogation was stopped and the individual was reported for her 

inappropriate behavior to the chain of command. 
18-20. Findings - Operation Iraqi Freedom. 

a. The Team interviewed four psychiatrists and psychologists (two presently 

assigned and two previously assigned) who provided direct support to the Joint 

Interrogation and Debriefing Center (JIDC) at the Abu Ghraib detention facility. These 

officers were assigned to this task through various methods. One was assigned to the 

General Staff of 'b"2'-2 ; 4 interviewees were listed on paper as part of a CSC with duty 

at the JIDC. The rating chain and technical reporting chains at this time are through the 

JIDC commander with senior rating by the Commander ofb. There is no overarching DoD or DA policy or doctrine for employment of medical 

personnel in a BSCT role. The first Abu Ghraib BSCT member, a physician, was 

assigned in the January 2004 timeframe and only remained onsite for 33 days. The 

officer developed a proposed job description that he could ethically execute; the duties 

included providing assessments for the psychological fitness of detainees to be 

interrogated. In June 04, a psychologist was assigned to the -staff. As a BSCT 

member, he served as a consultant and special staff officer. He did not wear the 

Medical Service Corps branch insignia but wore the General Staff insignia on his 

uniform. His BSCT role was to ensure interrogations were safe and ethical. He 

observed interrogations, consulted with interrogators concerning techniques, suggested 

wording and questions that the interrogator could use, and reviewed all interrogation 

plans. 

c. The BSCT personnel at Abu Ghraib did not provide medical services to the 

detainees. They did not have access to the medical records of detainees; however, 

they did have knowledge of detainee medical conditions. In recent months this has 

changed -they no longer have knowledge of medical conditions. The medical staff 

provides information regarding medically-related limitations for a detainee undergoing 

interrogation; however, the specifics of the medical condition(s) is not revealed 

d. The medical condition of detainees is not documented by BSCT personnel except 

in extreme examples. One BSCT member completed a psychological referral request 

for a detainee and, in another instance, informed the medical personnel when a 

detainee had a Post Traumatic Syndrome Disorder (PTSD) reaction during interrogation 

and was referred for mental health care. The BSCT personnel did not maintain medical 

records on detainees. 

e. Three of the four personnel serving as a BSCT at Abu Ghraib felt conflicted while 

working in that position. The conflict was based on three issues: (1) the BSCT 

personnel did not want detainees to view them as health care providers; (2) the BSCT 

role is an isolated position, an advocacy duty which can get lonely; and (3) concern 

about the lack of mental health services for detainees, especially the children (this was 

in January 2004 and is now rectified). The conflicts were resolved by seeking advice 

from trusted colleagues with more experience and establishing services to support the 

mental health needs of the detainees. 
f. All of the BSCT members thought that medical personnel should serve in a BSCT 

role for interrogation activities. One BSCT articulated that he did not think 

physicianslpsychiatrists should serve in this role since no medications are provided and 

it is not a health care provider position. 

g. In the training realm, all BSCT personnel were familiar with the Geneva 

Conventions and three of the four felt their training prepared them for addressing the 

human rights issues of detainees. 

h. At Abu Ghraib, no BSCT personnel observed possible detainee abuse in the 

interrogation setting. No cases of potential abuse have surfaced when a BSCT member 

was involved with interrogation. 

18-21. General Discussion 

a. In the purest sense, the mission of the BSCT is to provide forensic psychological 

expertise and consultation in order to assist the command in conducting safe, legal, 

ethical, and effective interrogation and detainee operations. Several of the 

psychologists and physicians described the position as a "safety officer" for the 

interrogation process. While serving in this role the objective is to: 

(1) Provide psychological expertise in order to maximize the effectiveness of the 

legal interrogation process. 

(2) Provide psychological expertise to assist the command in ensuring that the 

interrogation process is conducted in a safe, legal, and ethical manner. 

(3) Promote the overall effectiveness of detainee operations. 

b. The BSCT provides checks and balances in the interrogation process. Initially, 

BSCT personnel struggled with their role in this arena; the lack of doctrine and policy 

contributed to their "discomfort." The initial lack of an information firewall between the 

BSCT personnel and the medical records of the detainees provided a tenuous situation 

that was later alleviated by prohibiting BSCT personnel from having access to medical 

records. 

c. Those serving in a BSCT role did not feel the assignment of physicians in this 

capacity was the best utilization of their skills; they could be used more effectively in the 

patient care arena. In fact, physicians in this role only confused the situation since 

BSCT personnel provided no direct medical care or services. Psychologists have 

served in similar roles in Special Forces units, as well as in civilian forensic settings, 

and their background and training provides a foundation for duty as a BSCT member. 

d. The issue of "dual agency" for medical professionals serving in the BSCT role has 

been raised. Medical personnel serving in BSCTs understood their role and clearly 

understood they were not permitted to provide health care services. Recent published 
articles suggest that "physicians and other medical professionals breached their 

professional ethics and the laws of war by participating in abusive interrogation 

practices." There is no indication that any medical personnel participated in abusive 

interrogation practices; in fact, there is clear evidence that BSCT personnel took 

appropriate action and reported any questionable activities when observed. 

e. BSCT personnel sewed as protectors, much like a safety officers to ensure the 

health and welfare of the detainee under interrogation. In reviewing interrogation plans 

with the ability to halt interrogations at any time, BSCT personnel provide the oversight 

and checks and balances in the interrogation process. 

18-22. General Recommendations 

a. DoD develop well-defined doctrine and policy for the use of BSCT 

b. DA (preferably DoD) policy should permit only BSCT personnel to participate in 

interrogation planning. 

c. Psychiatrists/physicians should not be used in a BSCT role, 

d. All psychologists and behavioral health technicians serving in BSCT positions 

should receive structured training on the roles and responsibilities while functioning in 

this capacity. 

e. MI personnel should clearly understand the defined roles, responsibilities and 

limitations of behavioral health personnel serving in a BSCT position. 

f. All psychologists utilized as BSCT members should be senior, experienced 

personnel. 

Section VII' 

Medical Personnel Interactions with interrogators2 

18-23. General Findings 

a. Medical personnel participation in interrogations was exceedingly rare (five 

instances), occurred only in OIF, and occurred exclusively at units providing level I or II 

care. 

b. Evaluation or treatment of detainee patients was rarely (2.3%) delayed for 

intelligence gathering purposes. 

Note: Question sets were tailored by the Team for particular MOSijob duties. Therefore, all questions 

were not asked of all interviewees. This accounts for the differing numbers of interviewees responding to 

particular questions. 

This observation does not include information relating to BSCT personnel. 

1 
c. Medical personnel were rarely (5%) requested to be present during interrogations. 

d. Many interviewees reported that policies addressed the interaction between 

medical personnel and interrogators. However, dissemination and awareness of these 

policies was inconsistent. 

e. In OEF and OIF, dissemination and awareness of these policies improved for level 

Ill care personnel as the theaters matured. 

18-24. Discussion - Operation Enduring Freedom 

a. Interrogation Policies 

(1) 92 interviewees were asked if there was either a policy on interrogators, or a 

policy on conducting interrogations in their medical facility (Questions 62 and 63). 

(2) 43 interviewees provided level I and II medical care to detainees. 51% (22 of 

43) reported the existence of a written or verbal unit policy. 

(3) 49 interviewees provided level Ill care to detainees. The chart below details 

the percentage of "Yes" respondents at all level Ill facilities in the theater. "N" is the 

total number of respondents per MTF. Approximate MTF dates of service are included. 

OEF Level Ill MTFs: "Was there either: I) a policy on 

interrogators, or 2) a policy on conducting interrogations in 

their medical facility?" 

Jun 02 - Dec 02 Dec 02 - Jun 03 Jun 03 - Apr 04 Feb 05 - Present 
b. Delay of Initial Medical Exams 

(1) No interviewees were ever asked to delay an initial detainee medical 

examination until after an interrogation, and none delayed an initial detainee medical 

examination until after interrogation (Questions 128 and 129). 

(2) No interviewees were aware of others being asked to delay an initial detainee 

medical examination until after an interrogation, and none were aware of others who 

delayed a initial detainee medical examination until after interrogation (Questions 130 

and 131). 

c. Medical Personnel Presence During lnterrogations 

(1) The Team interviewed sixty-six (66) individuals and asked: 

(a) Had they ever been asked to be present during interrogations? (Question 65); 

(b) Had they ever been present during interrogations? (Question 66); 

(c) Were they aware of other medical personnel being asked to be present during 

interrogations? (Question 67); or 

(d) Were they aware of other medical personnel being present during 

interrogations? (Question 68). 

(2) 41 interviewees provided level I or II detainee medical care. 

(a) 7% (3 of 41) were asked to be present during interrogations; 

(b) 17% (7 of 41) were present during an interrogation; 

(c) 5% (2 of 41) were aware of others being asked to be present during 

interrogations, and 

(d) 15% (6 of 41) were aware of others being present during an interrogation. 

(3) 25 interviewees provided level Ill care. All answered "no" to all four 

questions. 

d. Medical Personnel Participation In lnterrogations 

(1) 78 interviewees were asked if medical personnel were ever asked to 

participate in interrogations (Question 57). 

(2) All answered "no." 
18-25. Discussion - Guantanamo Bay Detention Facility 

a. lnterrogation Policies. 9 interviewees were asked if there was either a policy on 

interrogators, or a policy on conducting interrogations in their medical facility. Three 

responded yes, three responded no and three reported being uncertain. 

b. Delay of Initial Medical Exam 

(1) No interviewees were ever asked to delay an initial detainee medical 

examination until after interrogation, and none delayed an initial detainee medical 

examination until after interrogation. 

(2) No interviewees were aware of others who were ever asked to delay an initial 

medical examination until after interrogation, and none were aware of others who 

delayed an initial detainee medical examination until after interrogation. 

c. Medical Personnel Presence During Interrogations. No interviewees were asked 

to be present during interrogations, were ever present during interrogations, were aware 

of others being asked to be present during interrogations, or were aware of others ever 

being present during interrogations. 

d. Medical Personnel Participation In Interrogations. No interviewee was ever asked 

or aware of medical personnel being asked to participate in an interrogation. 

18-26. Discussion - Operation Iraqi Freedom 

a. lnterrogation Policies 

(1) 883 interviewees were asked if there was either a policy on interrogators, or a 

policy on conducting interrogations in their medical facility (Questions 62 and 63). 

(2) 507 interviewees provided level I and II medical care to detainees. 27% (136 

of 507) reported the existence of a written or verbal unit policy. 

(3) 376 interviewees provided level Ill care to detainees. The chart below details 

the percentage of "Yes" respondents at all level Ill facilities in the theater. "N" is the 

total number of respondents per MTF. Approximate MTF dates of service are included. 

Many MTFs performed split operations and facility locations are annotated in 

parentheses. 
OIF Level Ill MTFs: "Was there either: 1) a policy on interrogators, or 2) 

a policy on conducting interrogations in their medical facility?" 

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03. JU~ ~ar 03 Mar 03 .Feb 04 -----Mar 03 - Mar04----- -------------Jan 04 - Jan 05------- 1u2)-2 ---------Jun 04 - Present

b. Delay of Initial Medical Exams 

(1) 4% (17 of 436) of interviewees had been asked to delay an initial medical 

examination until after an interrogation. 

(a) 1.4% (6 of 436) refused. 

(b) 2.5% (1 1 of 436) delayed initial medical exams. 

(2) 3.2% (14 of 435) of interviewees were aware of others being asked to delay an 

initial medical examination until after interrogation. 

(a) 1.4% (6 of 435) refused. 

(b) 1.8% (8 of 435) delayed initial medical exams. 

c. Medical Personnel Presence During Interrogations 

(1) The Team interviewed 777 individuals and asked: 
(a) Had they ever been asked to be present during interrogations? (Question 65); 

(b) Had they ever been present during interrogations? (Question 66); 

(c) Were they aware of other medical personnel being asked to be present during 

interrogations? (Question 67); or 

(d) Were they aware of other medical personnel being present during 

interrogations? (Question 68). 

(2) 495 interviewees provided level I or II detainee medical care. 

(a) 6% (32 of 495) were asked to be present during interrogations; 

(b) 10% (48 of 495) were present during an interrogation; 

(c) 8% (39 of 495) were aware of others being asked to be present during 

interrogations, and 

(d) 12% (57 of 495) were aware of others being present during an interrogation 

(3) 282 interviewees provided level Ill care 

(a) 2% (7 of 282) were asked to be present during interrogations, 

(b) 9% (26 of 282) were present during an interrogation, 

(c) 6% (1 7 of 282) were aware of others being asked to be present during 

interrogations, and 

(d) 13% (37 of 282) were aware of others being present during an interrogation. 

d. Medical Personnel Participation In Interrogations 

(1) 793 interviewees were asked if medical personnel were asked to participate in 

interrogations (Question 57). 

(2) 99.4% (788 of 793) answered "no." 

(3) 6% (5 of 793) participated in interrogations. Descriptions are below: 

(a) Two interviewees fluent in Arabic served as translators for interrogations 
(b) One interviewee fluent in Arabic was asked to gather intelligence for 

interrogator^.^ 

(c) One physician was asked to feign evaluations and treatment on detainees by 

(i) doing a DNA test from a hair sample, (ii) doing a DNA test from a buccal swab, or (iii) 

providing cough syrup but informing the detainee it was truth serum. The physician 

complied with the first two requests, but refused to comply with the third. He thereafter 

refused any further involvement by himself or any of his medical personnel. 

(4) One medic agreed to gather intelligence upon developing a rapport with 

detainees. 

18-27. General Recommendations 

a. DA guidance (DoD level is preferable) should: 

(1) Prohibit all medical personnel from participating in interr~~ations.~ This 

includes medical personnel with specialized language skills serving as translators. 

(2) Empower medical personnel to halt interrogations when any examination or 

treatment is required. 

b. All military personnel should be trained on the above recommendations. 

c. Scenario training is highly recommended. 

d. Follow-on competency evaluations should be incorporated into all training 

guidance and plans. 

Section Vlll 

Stress on Medical Personnel Providing Detainee Medical Care 

18-28. Findings 

a. 5% (41 of 803) of the interviewees (past) volunteered to discuss their personal 

experiences in providing care to patients in theater. No question asked medical 

personnel to volunteer their experiences and to describe the emotional impact of their 

The medic (interview #979) felt this role was inappropriate as he was unable to provide detainee 

medical care while serving as a translator. 

For purposes of this recommendation the term "participating in interrogations" refers to the 

participation by medical personnel during an interrogation. For example, asking questions would be 

active participation. Medical personnel who assist in developing the plan of interrogation are not deemed 

to be "participating in an interrogation." Likewise, actual presence in the interrogation room may not 

constitute "participating in an interrogation." For example, personal observation by medical personnel to 

ensure the health and welfare of the detainee is not deemed to be "participation in the interrogation." 

3 
experiences. If the question had been asked, the actual numbers of responses might 

be higher. 

b. 3.7% (30 of 803) of the interviewees reported that training should be required to 

prepare medical personnel for the ethical challenges and stressors associated with the 

theater environment, trauma care, detainee care, and the challenges of providing care 

with limited resources. 

18-29. Discussion 

a. 5% (41 of 803) of the interviewees (past) described their own personal 

experiences in providing care to patients in theater. No question asked medical 

personnel to volunteer their experiences and to describe the emotional impact of their 

experiences. If the question had been asked, the actual numbers of responses might 

be higher. Responses fell into the following categories: 

(1) Ethical dilemma of providing care to insurgents that killed or injured U.S 

Soldiers. 

(2) Providing care to U.S. Soldiers and Iraqis with limited medical resources 

(3) Quantity and severity of the injuries 

(4) Stress of a warfare environment. 

b. "If you were responsible for the training of medical personnel prior to deployment, 

what aspects of training would you focus on with regard to detainee care?" was asked. 

The majority of past interviewees answered the question (Q6-803 respondents and Q8- 

800 respondents). Thirty interviewees reported that training should be required to 

prepare medical personnel for the ethical challenges and stress associated with the 

theater environment, trauma care, detainee care and the challenges of providing care 

with limited resources. 

c. Some medical personnel reported that our interviews re-surfaced memories of 

their experiences. Several Soldiers identified the interview as the first opportunity to 

share personal experiences. 

d. Some medical personnel did previously discuss their deployment experiences 

because they had provided care to detainees. They felt that providing detainee care 

devalued their deployment experience. A hospital executive officer emphasized "the 

enormous difficulty of being on a ward 2417 with 20 detainees that just came off the 

battlefield from trying to kill American soldiers. There is no training scenario in the Army 

that prepares you for that" (Interview #234). The commander of a hospital described 

the extremely difficult work environment of the nursing staff providing detainee care. He 

then commented that he was very proud of their commitment to provide quality care. 

Several nurses assigned to a CSH talked about detainees hissing, spitting, defecating 
and urinating on the floors of the ward, despite the interpreters informing detainee 

patients this was unacceptable. Another interviewee commented that she was a middeployment replacement and that she received no pre-deployment training. She adds 

that medical personnel must be prepared for the psychological aspects of providing 

detainee care. 

e. Sixteen interviewees described the emotional aspects of caring for detainees. 

More specifically, five related their personal challenges in providing care to insurgents 

that killed or injured U.S. Soldiers. One nurse commented that "the detainee health 

care mission was very difficult and that there was much stress involved when dealing 

with detainees day-to-day and that sometimes personal attitudes changed, particularly if 

the detainees tell you that once they are released they will come back and kill you" 

(Interview #781). A physician characterized the "stress as unique in dealing with 

detainees; for example, the emotional aspect of dealing with those who were killing U.S. 

Soldiers and the responsibility in caring for them. Very difficult for the young medics to 

work through the ethics conflict" (Interview #400). A nurse simply conveys "preparing 

for the psychological effect of taking care of one who has tried to harm your fellow 

Soldier" (Interview #316). 

f. Although many interviewees commented on trauma training, only a few statements 

captured personal experiences relating to trauma care. For example, a nurse 

anesthetist describes "spending resources on Iraqis no differently than American 

soldiers. One thing that sticks in my mind is that we expended hardware, blood, 

medications, supplies on an insurgent who shot an American Soldier and then had to 

call for blood drives at night for the next Soldier because we had expended resources 

on Iraqis" (Interview #159). Another nurse anesthetist assigned to another CSH 

commented that training should be focused on the ethical dilemmas of caring for 

detainees since it was a struggle; for example, "a detainee was severely wounded and 

we gave him the required blood, knowing that we might not have the blood for our 

injured soldiers. This is something that we dealt with everyday" (Interview #685). A 

company commander commented: "It was very challenging to deal with massive 

trauma. There is no place to get away from it. The reality of war is tough" (Interview 

#212). Finally, a CSH Chief Nurse stated: "there's never a break, trauma everyday 

2417" (Interview #680). 

g. When asked "How comfortable did you feel discussing ethical issues related to 

detainee care with your immediate supervisor?" 934 of 993 (94%) (past, present and 

future) interviewees responded with "very comfortable" and "comfortable." Some 

commented that it was discussed regularly and others commented that it was not an 

issue; therefore, it was not discussed. Two medical treatment facilities reported 

convening an ethics meeting regularly (interviews #274 and #612). A few interviewees 

raised concerns and addressed them through the chain of command. 

h. 28% (43 of 152) pastlpresent respondents at level I in OIF graded availability of 

medications as either poor, fair or neutral and 26% (39 of 152) graded medical supplies 

as poor, fair or neutral. lnterviewees commented that medical materiel sets and the 
initial medical supply system did not provide for chronic illnesses, definitive and 

rehabilitative care necessary for detainee care; for example, a physician and two 91 Ws, 

all from different units, commented that, initially, they were not resourced to treat 

medical conditions such as diabetes and hypertension (Interview #s 693, 132, and 512) 

Many interviewees commented that the availability and use of supplies was the same 

for both U.S. Soldiers and Iraqis and there was no difference in who received the 

resources. A 91 W assigned to a MP unit commented "I used all of the resources I had 

for our Soldiers on the detainees and sometimes we didn't have enough" (Interview 

#95). 

18-30. Recommendations 

a. MEDCOM should establish an experienced SME Team comprised of a 

psychiatrist, a psychologist, clinical representation from all levels of care, and include 

representation from a Chaplain. The team should: 

(1) Comprehensively define the training requirements for medical personnel for 

inclusion into their pre-deployment preparation. 

(2) Consider revising CSC doctrine to effectively deliver support to medical 

personnel in theater. 

(3) Develop an effective system to regularly monitor post deployment stress. 

(4) Refine leadership competencies to assess, monitor and identify coping 

strategies of medical personnel in a warfare environment. 

b. AMEDDC&S should develop the training content defined by the above team. The 

above team should approve the content. The training (not ail inclusive) should include 

ethical dilemmas medical personnel face and the emotional aspects in providing care to 

insurgents and detainees. 

c. MEDCOM should assure post deployment mental health assessment of medical 

personnel and provide follow-up care. 

Section IX 

Interviewee Training Requests 

18-31. Training Questions 

a. The Team asked the following of interviewees: "If you were responsible for the 

training of medical personnel prior to deployment, what aspects of training would you 

focus on with regard to detainee care? Format? How often? When?" 

b. The following provides responses from pastlpresent OIF/GTMO/OlF interviewees. 
18-32. Operation Enduring Freedom 

a. Exceedingly few interviewees felt that current training was sufficient, and nearly all 

felt strongly that training in general needed significant upgrading. The most commonly 

recommended topics were: pre-deployment: cultural awareness training (including 

religious differences, local customs, accepted societal behaviors, diet, etc.), basic 

medical and conversational language training for the respective area of operation, 

emphasis on triaging and treating detainee patients and U.S./Coalition patients in the 

same manner, and Medical Rules of Care (ROC). 

b. Responses concerning the desired frequency of training were quite varied, 

including: annually, semi-annually, quarterly, and monthly for deploying units; during 

annual training (AT); and at all training locations with follow-up given at regular intervals. 

Responses were also varied concerning when the training should occur, to include: unit 

training at home station upon receipt of warning orders (varying from 30-365 days in 

advance of deployment) with increased training as mobilization approaches; just before 

mobilization with refresher in theater; and only in theater. 

c. For comparison purposes in some training areas, responses were grouped by 

officer and enlisted personnel. Officers (physicians, nurses, and PAS) generally stated 

a learning preference towards a Powerpoint lecture format (with topics including local 

endemic diseases), while enlisted personnel generally favored scenario-based and 

hands-on training (with topics including staff safety and the securing of detainees). 

18-33. Guantanamo Bay Detention Facility 

a. Responses were centered specifically on the provision of medical care while 

deployed to GTMO, including the security of detainees and universal precautions. 

b. Responses concerning the desired frequency of training were as similarly varied 

as the OEF responses. Nearly all stated that while training should occur before 

deployment, some form of refresher training should occur after arrival in theater. 

18-34. Operation Iraqi Freedom 

a. Training content suggestions were similar to those voiced in OEF, but also 

included: stress management for medical personnel; retraining for subspecialists utilized 

in other roles (e.g., primary care, ER, or general surgery); interactions with OGAs, MI 

personnel, and interpreters; field sanitation issues; preparation for long-term care of 

detainees; treatment of blast and gunshot injuries; and interest in having more MASCAL 

exercises. Of note, when Geneva Convention training was mentioned, only one 

interviewee recommended AR 190-8 training, reflecting a widespread lack of familiarity 

with this AR. Additionally, the number of responses that included desired training 

related to security of detainees was strikingly higher than those received in the other 

two theaters. 
b. Responses concerning both the desired frequency and the timeframe of training 

were also similar to those voiced in OEF, although some interviewees also wanted 

detainee training added to annual common task training (CTT) requirements. It was 

repeatedly recommended that refresher training in theater was universally desired 

regardless of when or where original training took place. It was also suggested that 

JRTC and NTC be made prime training locations for detainee operations. 

c. Desired training methods (lectures vs. scenarios) were also similar to those voiced 

in OEF. 
Chapter 19 

Non-AMEDD Training Sites 

Section I 

Overview of Non-AMEDD Training Sites 

The Team visited numerous non-AMEDD training sites to glean a perspective on 

training initiatives relative to the detainee health care mission. The visits 

provided critical insights into the types of training, and the time allocated for tasks 

pertinent to detainee medical operations. The Team interviewed personnel at 

JRTC, NTC, the PPPs and CRCs, and the MI school. 

Section II 

Joint Readiness Training Center (JRTC) 

19-1. Findings 

a. The Iraq theater is replicated at the JRTC platform. Two hundred to four 

hundred Iraqis are hired to play various roles to include the four to five terrorist 

groups. The majority of scenario play is trauma. The detainee center is located 

next to the hospital. 

b. The medical scenarios address detainee care from the point of injury to 

level Ill. When asked if simulated care was documented, the response was that 

it was very difficult to do the documentation in the limited amount of time 

provided to complete the task. 

c. It was reiterated that the observer controllers (OC) do not evaluate training, 

but observe the training. Therefore, OCs observe but do not evaluate medical 

ethics training, Law of War training and Geneva Conventions training. 

d. Medical ethics training as it relates to medical care is not annotated in the 

written AAR. 

19-2. Discussion 

a. OCs request tactical unit SOPs for review prior to start of exercise 

(STARTEX). If SOPs are missing, then the OC will coach them through to 

completion prior to STARTEX. 

b. There were no formal checklists, rather the OCs draw from their personal 

experiences. 

c. Scenarios are tailored to the needs of the unit's mission in theater and 

dynamic to reflect the changing picture in theater. 
d. OCs expressed concerns that there were no selection criteria to serve as 

an OC and it impacts on the quality of the training. It was mentioned that AC and 

USAR personnel often arrive with no deployment experience to serve as an OC. 

e. OCs stated their future plans are to develop scenarios to improve the 

quality of training. In order to improve the quality of training, they seek input from 

units in theater or from units that have recently returned. 

19-3. Recommendations 

a. Establish a SME team comprised of expertise from clinicians to develop the 

tasks and framework to formalize the training program. The framework should 

encompass all levels of care, from point of capture to care in the detention 

facility. 

b. The above team should assess the current training, specifically the 

scenarios to determine training deficiencies and determine the best practices in 

improving the quality of training as it relates to detainee medical care. 

c. Since AMEDD personnel must be prepared to provide care across the 

entire healthcare spectrum in theater, from the point of capture and collection 

point to the prison facilities, the training content should be developed by medical 

personnel with exceptional knowledge of detainee care. Additionally, the team 

should be comprised of representation from JAG, a medical ethicist, and subject 

matter experts serving in the prison health care system. The team members 

should develop the content and the JRTC medical OCs should facilitate. 

d. Team membership should include representation from the NG and USAR 

personnel that served in these facilities as well as the active component. 

e. The training should include a crosswalk of DoD and DA regulations and 

policies pertaining to detainee medical care. Training content should be revised 

regularly to reflect changes in the policies. 

f. Define competencies for observer controllers. Ensure OCs are from every 

component. 

Section Ill 

National Training Center (NTC) 

19-4. Findings 

a. The NTC scenario has evolved to mirror the Iraqi theater 

b. The NTC Rules of Engagement (ROE) have evolved to include detainee 

operations including medical care. 
19-5. Discussion 

a. In 1999, the NTC scenarios first incorporated Civilians on the Battlefield 

(COB) training. This was not medical training per se and there was no casualty 

play or casualty evacuation of COBS at that time. Since the start of OIF, the 

scenario for NTC changed significantly and on a large scale. No longer was the 

linear battlefield and high intensity conflict the focus of the training scenarios. 

Specifically, the scenario changed so that the cantonment area simulates the 

experience of Kuwait in the deployment process. In the box, the scenarios are 

focused on Iraq with a large amount of realism. There are now Forward 

Operating Bases (FOBS) established at the battalion level for the scenario 

training. Also there are lraqi cities in the box with lraqi nationals hired as 

contractors from the Titan Corporation. They speak Arabic and interact with the 

training soldiers in as realistic manner as possible. 

b. In 2002 to 2003 the NTC ROE changed. Prior to this, Opposing Forces 

(ORFOR) automatically became killed in action (KIA) if captured and there was 

no scenario play for detainment operations or detainee care and support 

(including medical). Detainee Operations are now part of the standard scenario 

training and the medical ROE is a big part of the planning including treatment, 

evacuation, and care. In the Leader Training Plan (LTP) "pre-course," the 

medical ROE is briefed to include information on entitlement and treatment. 

Medical leaders are provided with references in the form of the 8 and 4 series 

FMs as well as access to the Tarantula AKO shared site which has the actual 

medical ROE for OIF, FMs, and example tactical SOPS (TACSOP). Access to 

this AKO shared sight is for all who request subscription on the AKO site at: 

AKO 3 Files 3 US Army Organizations 3 FORSCOM 3 Irwin 3 NTC 

Operations Group 3 Tarantula Team 3 Tarantula 214 3 Rotational folders. 

c. Resources available to deploying units include the JTF-7 Smart Card with 

non-medically related translation phrases. Units are informed of this resource 

and of the Palm Phrasalator software that is used by some in the field to do 

translations for medical and non-medical purposes. 

19-6. Recommendations. The Team endorses the following specific 

recommendations from the NTC trainers: 

a. Add a detainee medical operations specific task to the Expert Field 

Medical Badge (EFMB) task list. 

b. Add detainee medical operations into combat lifesaver (CLS) training -the 

true first interface between the fighting force medical provider and the detainee. 

c. Commanders need to incorporate detainee medical operations into the 

METL. 
Section IV 

Power Projection Platforms (PPPs) 

19-7. Findings 

a. PPPs do not offer classes on the generation, collection and storage of 

detainee medical records or on specifically reporting detainee abuse. 

b. Training at the PPP is directed from 1' Army or 5thArmy. It is 

undetermined if enough time could be allocated at these facilities to conduct 

training specifically geared to prepare medical units for a detainee care mission 

in theater. 

c. PPPs offer generic Law of War and Geneva Convention classes to soldiers 

deploying to OEF, GTMO, OIF. The training is not unit or theater-specific. 

19-8. Discussion 

a. PPPs provide training for deploying soldiers, including a Geneva 

ConventionlLaw of War class, often provided by the local legal office. This 

training is not sufficient to educate medical personnel deploying to a detainee 

healthcare mission in theater. 

b. No training is provided on the generation, storage and collection of 

detainee medical records or for recognizing and reporting detainee abuse. 

Medics are often employed at the PPPs to cover ranges or to teach CLS 

courses. 

c. Few PPPs offer theater-specific training. 

d. Guidance for mandatory training leaves little time to incorporate additional, 

necessary, training into the schedule. 

e. Training, while meeting the guidelines from higher headquarters (HQ), is 

widely varied across the PPPs. Detainee Operations training is very detailed for 

deploying MP units, but not medical units. 

f. FTX training at the PPP does allow for unit-specific METL training. 

19-9. Recommendations 

a. PPPs need to ensure medical personnel deploying are able to use their 

time at the training site to prepare for their upcoming mission. They should not 

be tasked with non-training missions (such as providing routine medical care) 

unless a quantifiable training effect can be assessed from such medical care. 
b. PPPs need to make their training "theater-specific" to ensure Soldiers 

processing through are adequately informed of any unique theater challenges or 

dangers. 

c. Geneva ConventionILaw of War training needs to be improved upon by 

reflecting current rules of engagement and ethical challenges facing Soldiers. 

Emphasis needs to be placed on reporting suspected or actual abuse. 

d. Units should still bear the responsibility of training soldiers on detainee 

medical records. 

Section V 

CONUS Replacement Centers (CRC) 

19-10. Findings 

a. CRCs do not provide classes on the generation, collection and storage of 

detainee medical records or on reporting detainee abuse. 

b. It is undetermined if time can be allocated at these facilities specifically to 

prepare medical personnel who are deploying to a detainee care mission. 

c. CRCs offer Law of War and Geneva Convention classes to deploying 

individuals. Ft Bliss' CRC does make these classes theater-specific. 

d. Ft Bliss' CRC provides a detailed detainee operations class, "Process 

Enemy Prisoners of WarlCivilian Internees (EPWsICis) at a Collection Point or 

Holding Area" (Cit. 48), geared more toward MP and combat arms Soldiers. 

19-1 1. Discussion 

a. The training provided on Geneva ConventionILaw of War is lecture only 

and provides no scenario based exercises. 

b. The time constraints on personnel processing through CRCs significantly 

limits increased training opportunities. 

c. Personnel qualified to instruct detainee medical care classes are currently 

not available. 

19-12. Recommendations 

a. CRCs need to look at opportunities to expand current detainee operations 

training to include more comprehensive teachings on reporting suspected or 

actual detainee abuse. 
b. Geneva ConventionILaw of War training needs to be improved upon by 

reflecting current rules of engagement and ethical challenges facing Soldiers and 

use a scenario based component to enhance learning modalities. It needs to 

emphasize reporting suspected or actual abuse 

c. Units should still bear the responsibility of training soldiers on detainee 

medical records. 

Section VI 

Military Intelligence Training 

19-13. Findings 

The Enhanced Analysis and Interrogation Training (EAIT) advanced individual 

training (AIT) course includes specific training on interacting with BSCT 

members. 

a. 97E AIT includes instruction that interrogations should be postponed or 

interrupted if a detainee requires any medical evaluation or treatment. 

b. The EAlT course includes specific training on interacting with BSCT 

members. 

19-14. Discussion 

a. Personnel with the 97E MOS receive a Law of War briefing from the MI 

JAG office. The only training in the 97E AIT which focuses on interacting with 

medical personnel emphasizes that any ill or injured detainee is to have an 

interrogation delayed or interrupted so that medical care can be administered 

promptly. In the FTX portion of 97E AIT none of the scenarios include moulaged 

or injured detainees; however, current scenarios do cover the need to report all 

suspected abuses inflicted by any other interrogators. 

b. New interrogation training doctrine is being developed at the current time. 

There was a plan to include the interfacing of students with medical personnel, 

with the goal of increasing sources of general intelligence about detainees. This 

training is not specifically included in the 97E AIT, since this not described within 

current training doctrine. However, when current students ask trainers about 

using medical personnel as sources of general intelligence, this is not 

discouraged. 

d. The EAlT was established as an advanced course for Human Intelligence 

Collectors and Intelligence Analysts who would be working at the GTMO 

detention facility. The curriculum for the EAlT course is very dynamic, and rather 

than being driven by doctrine, as is the 97E training, it appears to be driven by 
the leadership needs at GTMO for their ever-changing personnel staffing 

needsldesires. However, even though this course was in fact originally 

established with a focus on GTMO, many current and future students will be 

assigned to other theaters of operation. 

e. The EAlT course emphasizes the need for students to interact with medical 

personnel, in particular the BSCT staff; in theaters of operation this interaction is 

intended to occur 2-3 times per week at a minimum. Students are trained about 

the roles of the BSCT staff, which include: checking the medical history of 

detainees with a focus on depression, delusional behaviors, manifestations of 

stress, and "what are their buttons." Students are also trained that BSCT staff 

will greatly assist them with: obtaining more accurate intelligence information, 

knowing how to gain better rapport with detainees, and also knowing when to 

push or not push harder in the pursuit of intelligence information. 

f. During the EAlT course, trainee competency is evaluated during their 

planning phase for interrogation and analysis, and failure to interact with the 

BSCT staff is a "NO-GO" in this process. 

19-15. Recommendation 

DA, or preferably DoD, should exercise oversight in the revision of current 

interrogation training doctrine to ensure compatibility with the Geneva 

Conventions, the Law of War, and all policies that apply to medical personnel, 
Chapter 20 

lncidents and Allegations 

20-1. This lncidents and Allegations Table (IAT) groups events by theater. Based on 

the number of OIF entries that theater is further subdivided into the following categories: 

a. Medical records 

b. Medical ~racticelbehavior 

c. Interrogations 

d. Staffing shortages 

e. Reuse of supplies 

f. Supply shortages 

g. Detainee environment 

h. Potential abuses by USlCoalition Forces 

i. Potential abuses by Iraqis 

20-2. The Team identified numerous examples of medical personnel reporting 

suspected abuse (to medical supervisors, the chain of command or CID). Medical 

personnel also made on-the-spot corrections and added or changed policies and 

procedures to prevent reoccurrences. 

20-3. The Team referred 3 cases for further investigation (two to CID and one to the 

chain of command). 

a. Procedure performed on a dead Iraqi. This had been investigated in theater and 

the Soldier received a letter of reprimand. Referred to CID (IAT #72). 

b. Medical personnel providing sedatives to a detainee potentially for interrogation 

purposes; observed by 1 interviewee, but not confirmed by additional interviews. 

Referred to chain of command (IAT #41). 

c. Medical personnel failed to report detainees restrained in excessive heat without 

adequate water. Referred to CID (IAT #93). 

20-4. Many of the listed allegations are either unsubstantiated or disputed by other 

interviewees. 
20-5. The Team found conflicting interview results concerning the possible reuse of 

certain medical supplies. 

20-6. The initial level of staffing and resourcing of supplies, combined with excessive 

lengths of stay for detainee patients at some level Ill facilities, at times limited the ability 

of these facilities to readily accept transfer detainee patients. 

20-7. Allegations discussed by media reports and published articles often involved 

inaccurate facts. Several medical personnel who were interviewed for media stories or 

other publications state they were misquoted. 

a. Close in time suspicious detainee deaths. Both deaths were ultimately 

determined to be homicides. The first death was not originally classified as a homicide. 

The changing of the death certificates are unfairly mischaracterized as an attempted 

cover-up (IAT #2). 

b. Intravenous Infusion (IV) placed into a deceased Iraqi. CID had been notified 

(Investigation later concluded that detainee death was abuse-related). An IV was 

placed in the body prior to transport to make detainee appear to be alive. The purpose 

of the unneeded IV was to reduce the risk of a riot by detainees. Mischaracterized as 

an attempt to cover-up cause of death (IAT #9). 

c. Internists and other nonphvsicians carrvina out amputations and other procedures 

performed by suraeons. Provider treated a detainee with a nearly severed limb. 

lnterviewee claims he was misquoted (IAT #14). 

d. Dentist performing open heart surgery. No evidence found to support this 

allegation (IAT #15). 

e. MP suturinq a detainee. Incident was investigated fully by CID. Confirmed (IAT 

#I6). 

f. Inadequate mental health assets for detainee care. Individual claims he was 

misquoted. He did not perform the duties of a psychologist in theater but as a medical 

platoon leader (IAT #I 7). 

g. Physicians desiqned interroqation techniques. This statement is misleading. 

Medical BSCT members did monitor interrogation techniques to ensure the welfare and 

safety of detainee interviewees. Medical personnel were empowered to immediately 

stop any interrogation being conducted within Abu Ghraib based on health or safety 

concerns (IAT #37). 

h. Revivinq a detainee for continued interroqation. No evidence found to verify or 

disprove the allegation. Undetermined (IAT #38). 
i. Reuse of medical supplies. Conflicting statements by various interviewees. 

Undetermined (IAT #48). 

j. Medical supply shortaqes. Confirmed (IAT #57) 

k. Use of a leash for a detainee. Interview statements provide explanation for limited 

use as a restraint tool on a single mentally unstable detainee. Explanation is not fully 

stated in article (IAT #73). 

20-8. The Incidents and Allegations Table summarizes in one location the events 

deemed by the Team to be significant. The Team made a good faith effort to interview 

all known medical personnel involved in the listed incidents and allegations. 
----- - 

------- 

------- 

OEF 

Interview Did not observe abuse but was aware of two detainees brouqht in for post mortem examination who died under suspicious 

detainee death #314 circumstances. The deaths were investigated by CID. 

2. Suspicious Interview A detamee death was initially thought to be secondary to a pulmonary embolus, and not related to any abuse. The interviewed TF 

detainee deaths #899, Commander requested an Armed Forces Institute of Pathology (AFIP) autopsy thru CENTCOM and arranged for international 

NEJM physicians (German and Jordanian) to attend. After a second detainee died shortly thereafter, the AFIP forensic pathologist 

29 July 04 returned with a Jordanian and Korean physician in attendance for that next autopsy, and the first death was evaluated again. This 

(Lifton) time the cause of death was determined to be homicide. A 15-6 was directed bv CJTF-I 80 commander. CID did a complete 

(Cit. 35) ~nvest~gationThe Team rev~ewed the final autopsy reports and confirmed that both deaths were concluded to be homicides 

3. Allegation of E-mail from Unknown Kandahar The surgeon report~ng th~s ~ncident stated ~t was unclear ~f the photos were real or fake. Alleyat~on referred to CID by Ft Benning 

photos PROFIS MTF commander for investigation 

document~ng Surgeon 

multiple Afghan 

detainee 

physical abuses 

4. Uzbek Interview BIT Jul 03- Shkin Sent to CID for ~nvestigation; no fault found. 

detainee in #378 Apr 04 

Afg han~stan 

captured and at 

next level 

reported prior 

physical abuse 

GTMO 

5, Inappropriate I BSCT #6 I BIT Jun 02 - I GTMO I There was one mcident where a BSCT member was aware of potential abuse as he was present when the FBI discussed the .. . 

interrogator I I Dec 02 I 1 incident with the JIG Commander. Apparently the abuse involved an interrogator pulling on the thumbs of a detainee 

techn~ques 

6. lnau~ro~riateI BSCT #5 BIT Dec 02- GTMO 1 BSCT member re~orted a auestionable incident where a female interroaator took off her BDU iacket, rubbed her breasts aaainst 

interrogator I May 03 the body of the detainee being interrogated sat on his lap, and whisperid in his ear. The interrogation was stopped and ice 

techniaues ~nd~v~dual was re~orted for her ina~~ro~r~ate behavior. 

OIF 

OIF - MEDICAL RECORDS ISSUES 

7. Burn~ngof Interview BIT Jan-Mar lnterviewee #431 stated: (b)(2)-2 Jmentioned that the records were burned after discharge." Interview #271, assigned tol(b)(2)-2 J 

medical records #431/#271 04 claims records were maintained by the CSH. Unconfirmed on both accounts. 

8. Burning of Interview BIT Jan-Nov Mosull Admitted that as S-31s-2 he would burn records of those detainees not transferred. Interviewee #681 claims records were 

medical records #4351#681 04 Balad ma~ntained by themand copies were given to MPs going to "Area 51" with a detainee. then contradicts by saying they have 

no idea what happened to the original records after going to "Area 51". 
9. Death of a NEJM BIT Jul 03- Abu Ghraib The medics and #917 were contacted to evaluate a detainee who was found to be dead upon their arrival. He had a sandbag by 

detaineelplace- 29 July 04 Mar 04 his head, a cut over his eye, chest contusions, his knees were "scuffed up," and he exhibited raccoon eyes. #970 documented his 

ment of IV and (Cit. 35) findings (physical), but he did not sign a death certificate. #970 was called to pronounce the detainee dead (he has a report in his 

packed in ice Time Mag possession because he did not know how to file this report on an unidentified person). He stated that the detainee had already 

07 Feb 05 been pronounced dead by the Iraqi physician on call. This detainee had no prison number, had apparently just been captured. and 

(Cit. 47). was not a prisoner of the US. military, but of an OGA. Autopsy was recommended. #698 stated that he was called down with 

lnterview #9l7 and another medic. The medic was instructed to place the IV by the JlDC Director (with OGA personnel present). The IV was 

#9701#9171 placed to prevent the other detainees from rioting (confirmed when investigated by CID). The body was packed in ice and 

#698 transported to an unknown destination. According to #705, the JDlC Director ordered them not to discuss the incident to anyone, 

including the B Co ~ommander,lo(2)-2ii705 was unaware of incident until interviewed by CID. Also investigated by CIA. 

10. Possibility of Interview BIT Jul 03- Undeter- Stated that while working with /(b)P-2 on two separate occasions, he was pressured by OGA 

fals~fying #415 Mar 04 mined personnel into fjlling out death cert~ficates on Iraq1 Detainees. Stated he was not given the opportunity to examlne the dead. 

detainee death Causes of death were later found to be inaccurate. CID investigated 

certificate 

11. Interview BIT May-Jul Baghdad lnterviewee stated: "Changed the spelling of m last name on detamee records; I was told the paperwork would be given to 

Misrepresenta- #595 04 detainees uoon release." Was attached to theeat the time. 

tion in med 

records 

Olf - MEDICAL PRACTICE/BEHAVIOR ISSUES 

12. Physician FayIJones Dec-03 Abu Ghraib An MI soldier, in her testimony for the Fay /Jones report, stated that she found a detainee in his cell with a Foley catheter in place 

refusing to treat report1 but without a collection bag attached. She states that she contacted the physician on duty that night and he refused to see the 

a detainee. lnterview patient or attend to her concerns. The Team contacted the MI Soldier to get more information about who this physician was. She 

#897/#9041 did not remember h~s name, nor remember ~fhe was an LTC or a COL, but stated that she could identify him in a picture if given 

E-mail one. The Team spoke to many medics and the few physicians that were working in Abu Ghraib around the time of this incident. 

correspon- The Team was not able to identify this phys~cian. #970 does not meet the description and #706 re-deployed November 03 per 

dence to email msg dated 25 Mar 05 to Team member. 

Team (Cit. 

24) 

13. Failure to Public May-04 Kufa Started an interview on this medic who informed the Team member he had been interviewed about six times by CID concerning an 

prov~dedetainee adm ~ssionl incident where a Company Commander had shot a wounded Iraqi. He said the subject had "half his head blown off" and ~t was the 

care Interview by worst head wound he had ever seen. He told me that he did not treat the patient because he was "expectant." He did not report 

Team the incident because an unmanned drone caught it on film. The case was brought to light by the media during the Company 

member Commander's court-martial. 

14. "Internists Time Mag BIT Jul 03- Abu Ghraib There were approximately 130 casualties, including some with open chest wounds and traumatic amputations. #916 stated that he 

and other 07 Feb 05 Mar 04 thought ihe Time Magazine interview was about staffing shortages and a shortage of supplies. During the interview, he mentioned 

nonphysicians (Cit. 47) I that he cared for amputees. Several of the casualties sustained traumatic limb amputations in which the limb was not salvageable, 

carrying out NY Times but had skin attaching it to the body. #915 did not perform any amputations. In cases where the limb was salvageable, the 

amputations and 04 Feb 05 extremrty was wrapped and the patient was evacuated. lnterviewee stated he felt misrepresented by the article. A patient was 

other procedures (Cit. 36). admitted to the hospital with Diabetic Foot Ulcer. The patient did not respond to the antibiotic therapy. The orthopedic surgeon 

performed by lnterview performed the toe amputation in the OR. 

surgeons". #916/e-mail 

correspond 

ence to 

Team from 

#818 
Incidents1 4 
 Alle ations

15. Dentist 

allegedly doing 

heart surgery 

16. Two 

detainees' 

depositions 

describe an 

incident where a 

medic allowed a 

med ically 

untrained guard 

to suture a 

prisoner's 

laceration 

17. Inadequate 

mental health 

assets for 

detainee care 

18. Line medic 

given the 

authority to not 

treat patients 

19. Contract 

Iraqi physicians 

secretly taking 

medications 

prescribed to 

deta~nees to sell 

on the black 

market 

20. Abuseof a 

detainee by a 

nurse 

21. Abuse of 

detalnee by 

nurse ate 

NY Times 

04 Feb 05 

(Cit. 36)i 

Interview # 

904/#705 

Incident 

#21 in FayJones. 

Lancet 

(Miles) (Cit 

30): 

Interview # 

698 (2nd 

visit to the 

unit) 

NY T~mes 

14 Feb 05 

(Cit. 36)l 

lnterview 

#974i#705 

lnterview 

#545 

interview 

#246 

lnterview 

#717 

lnterview 

Date of 

Incident! 

Allegation 

BIT Mar 03-

Apr 04 

Late 2003 

BIT Apr 03- 

Mar 04 

BIT May 03- 

Jul04 

Spring 2003 

Early 2004 

B/T Jan 04- 

Nov 04 

Abu Ghraib 

Abu Ghraib 

Abu Ghraib 

Baghdad1 

Najaf 

Baghdad 

Balad 

Balad 

#904 stated there was no dentist assigned to Abu Ghraib during Mar 03 to Jan 04. #705 slated that a dentist may have assisted 

with the insertion of chest tube during a mortar attack, but did not perform open heart surgery. It is unclear when this allegation 

could have occurred. 

#698 (corn bat med~c((~)(~)-~ / was asked by MP if he could piace a suture. The MP ~nformed #698 that he was a trained 

Combat Life Saver. #698 monitored the placement of the suture and subsequently monitored the detainee for signs of infection. 

The wound healed w~thout difficulty. The detainee statement in the FayIJones report states that "a doctor" allowed one of the 

guards to do the suturing. This is not accurate. Interview #705 (physician.[b)(2)-2 was not aware of the incident until 

CID notified him in Theater. #705 questioned #698 about the incident and verbally counseled him that a PA or physician needs to 

review and concur with plan of care before suturing in the future. Inc~dentwas investigated by CID. 

#974 (70B, Platoon ~eader/(~)(~)-' was contacted by (b)(6)-2 [bioethicist) for a telephonic interview for the 

NEJM. It was #974's understanding thatmsought information to improve care. He asked #974 about mental health issues. 

knowing that #974 was a professor of psychology and counseling. #974 informed him that about "5% of the detainees suffered 

from mental illness." #705 is auoted in the article as follows "for lona ~eriods. there was no one to treat mental-health ~robiems u a 

among inmates, no doctor qualified to prescribe ant~psychot~c drugs and other drugs that could have calmed mentally ill detainees." 

#974 stated tha-nferred that #974 was petforming mental health services. #974 stated that he did not perform mental 

health services and explained that toO(61-2as well. He said that-bsked him about BSCTs and he Informed him that he had 

never heard of that term. #974 stated he was misrepresented in the Times article. The NEJM 06 Jan 051W5-2 

does discuss BSCTs but does not does not mention #974's comment. The Times article does mention #974's comment, but quotes 

#705. 

#545 stated that he was given the authority by the platoon leader to not treat detainees at point of capture who were considered 

"too far gone." Once told by Platoon Leader ofkbP-2 that he had the option of providing medical care to detainees or 

not. Was also told by a Medical NCO in Sadr City that he, the Medical NCO, did not always treat detainees at point of capture. 

Said he treated US personnel first and then deta~nees if there were enough medical supplies. Team could not locate these two 

individuals. 

Reported through chain of command; responsible individuals fired from contract positions. 

The nurse interviewed from the ICU reported that he felt that a nurse from the ICW was abusing detainees. He didn't report it, but 

counseled the nurse himself and obtained a rights warning card from the MPs. He then threatened to bring the nurse up on 

charges if his treatment of the detainees did not improve. No additional incidents noted. 

Nurse struck detainee after he grabbed her. COC notified, administrative action taken. Confirmed by interview #I66 The 91WM6 

was reprimanded in writing for attempt~ng to defend herself when a detainee grabbed her. #937 believes she tried to choke him or 

push him away. For corrective training, she provided classes on Law of War and the Geneva Conventions with respect to detainee 

care. 
Date of 

Incident! 

Allegation 

-

22. Death of a Interview 2004 Baghdad The(b1!2)-2 I commander interviewed describes an rncident where a detainee died from a subdural hematoma. At the time of the 

restrained #7ll fall, the detainee was restrained to his bed by one wrist and one ankle restraint. The commander determined that the fall was 

detainee who fell caused by the method of restraint (root cause analysis) and the hospital restraint policy was changed. 

due to the 

restraint 

23. Observed lnterview BIT Mar-Oct Baghdad Confronted individual, assigned to theo(2)-2]on the spot; reported to OR head nurse. No further incidents 

junior #I2 03 

Anesthesiologrst 

drop a l~tter with 

a detainee 

patient hard on 

purpose three 

times 

24. Staff nurses lnterview BIT Aug 03- Balad Reported to Nursing chain of command at them1 practice stopped. 

appeared to hold #582 Feb 04 

pain medications 

on detainees to 

absolute time 

lhmit of med 

order -

25. Staff lnterview BIT Aug 03- Balad Reported to Nursing chain of command at the(bW-2 practice stopped. 

possibly feeding #582 Feb 04 

detainees MREs 

with pork 

products on 

purpose 

26. Alleged 

directive to 

lnterview # 

398/M631# 

2004 Northwest 

Iraq 

#398 reported that medical personnel were not allowed to give detainees any pain medications, even Tylenol, Motrin or as irin by 

order of the detention facility commander forkb)(2)-2 The Team determined that he was actually talking about & 

withhold pain 459 b)(2)-2 He brought his concerns to the PA and Bn surgeon. Two other medical personnel were interviewed froml(b)(21-2 

medications from 3)(21-2 The BN Surgeon, #459, stated that all detainee medical resources were good, including medication resources, and that all 

detainees the resources were the same and not se~arated. Interview #463 was asked soecificallv if there were directions from his command 

-

about limiting resources for detainees and he stated "no." 

27. Delay in Interview Spring 2003 Kuwait The first time detainee casualties from Iraq landed at the landing zone {LZ) for thdb)(2)-2 in Kuwait, there was an argument 

care of critically #239 among thaleadership about providing detainee care in-~uwait. The casualties waited on the LZ without care-for two hours. 

injured detahnee This resulted in significant patlent care delay without changing patient outcome. Themlater received approval to treat such 

detainee emergencies in Kuwait. 

28. Quality of lnterview Summer 2003 Bucca #729 describes watching a medic from another unit attempt to put an IV in a detainee multiple times. The medic placing the IV was 

care for a #729 "not very good at placing IVs, was yelling at the detainee to cooperate with her, and told the interpreter that she wouldn't care for 

detainee the detainee if he didn't start to cooperate." The interviewee intervened and placed the IV herself and counseled the medic on the 

spot. 

29. Quality of lnterview # Late 2003 Abu Ghraib When influenza vaccines were available, the unit administered them to detainees. #444 and other medics were counseled from the 

care for 44 4 MP higher HQ for administering flu shots to detainees. Regardless, #444established a protocol to administer flu shots first to 

detainees detainees with chronic illnesses, and then to the other detainees. 

30. Refusing to lnterview Spring 2003 Baghdad The interviewed physician from Camp Cropper (BIAP) recounted a significant problem with detainees having advanced stage TB. 

accept detainee #I72 #I72 reports one child hemorrhaging from his cavitary TB and dying. After that happened he developed a four-drug therapy 

patients protocol for TB. He reports that one of his detainee patients was desaturating due to his TB and that th~o(2)2refused to accept 

this patient in transfer even though there were not the appropriate medical resources at BIAP to treat him. He states that ultimately 

he stopped calling ahead to thekwto let them know he was transferring detainee patients to ensure that he would not have 

these patients blocked for transfer. He was concerned that when he called to report on a critically injured patient he was 

transferring, the first question he was always asked was "is this a US soldier or a detainee?" He was concerned that this conveyed 

a bias against accepting detainee patients. 
31. Refusing to Interview BIT Apr 03- Baghdad Thrs medic at Abu Ghraib reports that the medical evacuation resources for detainees were poor and felt this was due to the/bJ[2'-2 

accept detainee #4441#904 Apr04 refusing to accept patients in transfer. Two patients that were particuiarly memorable were a patient with a base of the skull 

patients fracture and a watient with ~artial hand amwutation. Ultimatelv. the fracture ~atient was accewted in transfer to t h e 7 which 

then transferred him to thecb,c'i-2/ior ~evk~Ill care. (lnterview# 444) His NCOIC (also a medic) reports contactidg his Bn 

command who in turn would contact the BDE command who in turn would contact the(bJW2 who would contact t h e 7 

to transfer these patients. Neither of these medics spoke directly to anyone at thev~he~ did report that once they found 

thdb1'2)-2 the sto ed trying to send any patients to th@!"'-' land never had a problem having a detainee patient accepted 

for transfer thdfy+l 

32. Appropriate lntervlew BIT May-Oct Baghdad =(board certified Family Practice physician) reports that he would send detalnees from the BlAPlHVD detention facllity to thep "J~' support of level ll #I721#695 03 for subspecialty consultation. They would be seen by a PA or an NP doing acute care and sent back with the consultation 

medical unit b completed by that person, instead of the specialist. He felt this was inappropriate. #695 learned that PAS were running the 

thi@m+ screening clinics and were not prepared to manage complex medical illnesses. #695 met with th@[ZJ-2 XCS to discuss his 

concern. No change in this practice occurred; therefore. he stopped sending these patients and treated them himself at thelb"2).2 1 7/i 5 bed Aid Stahon. 

33. Appropriate Interview BIT Mar-May Baghdad This physician states that early on in the war (Mar 2003 - May 2003), detainees were being sent back to the HVD detention faciiity 

support of level II #I 72 03 with external fixators in place. He felt this was inappropriate because they were sleeping in the dirt and had a very high risk of 

infection from their environment. He complained about this to[b)lz,zcornrnand and ultimately, by June 2003, the/bl[z]-z 1 b112~2 lsent a delegabon of command staff to the HVD detention facility to see what the environment was for the 

detainees. After they saw the conditions, they stopped sending patients back that couldn't safely receive their post-operative care 

at the detention facllity. 

34. Appropriate Interview BIT Mar-Aug Baghdad #I72 recalls a conversation he had with the OMF surgeon from the1bx2h2 that concerned him. #I72 had sent a patient with an 

care of #I 72 03 open facial fracture involving the maxillary sinus from the BlAP to the(b"2)-2 3
He asked the OMF surgeon how this patient was 

doing when he next saw the OMF surgeon and #I72 reports that the OMF surgeon told him that she didn't remember the patient. 

#I72 reports that the OMF surgeon then asked if the patient was a US soldier or a detainee and when #I72 stated this was a 

detainee, #I72 reports that the OMF surgeon stated that she didn't always get called on the detainee patients. 

OIF - INTERROGATION ISSUES -

35. Interview Mosul Detainee with a gunshot wound simultaneously interrogated in aid station, according to #398. Others interviewed did not mention 

Simultaneous #398/# this or other similar episodes. Soldiers assigned to'b)(2'.2 I 

treatment and 68/#452/#4 

interrogation of a 53/#454/#4 

detainee 56/#460 

36. Interview Mosul Detainee with a gunshot wound simultaneously interro ated in aid station, according to #398. Others interviewed did not mention 

Simultaneous #398/# this or other smilar episodes Soldiers assigned topF71 

treatment and 681#452/#4 

interrogation of a 53/#454/#4 

detalnee 56/#460 

37. "Army Lancet BIT Jan -Feb Abu Ghraib #734 is the "physician" referred to In this article. #734 reported that he and his EMEDS Commander wrote the CONOPS for the 

officials stated article 04 JIDC DHT. As the DHT physician, he helped to monitor interrogation techniques. not monitor interrogations directly. Also, he did 

that a physician (Miles); not develop Interrogation techniques. He did not approve techniques, but rather had the authority to stop any technique used 

and a Interview anywhere in Abu-Ghraib on the spot and without approval of the BDE FOB Commander. # 734 felt that the Lancet ariicle 

psychiatrist #734, misrepresents his actual duties at the JIDC. 

helped design, #BSCT 9 

approve, and 

monitor 

interrogations at 

Abu Ghraib." 
4 Date of 

Incidents1 Incident! 

Alle ations Allegation 

38. "In one Lancet Abu Ghraib The Team found no evidence to verify or disprove this allegation. 

example of a (Miles) 

compromised 

medically 

monitored 

interrogation, a 

detainee 

collapsed and 

was apparently 

unconscious 

after a beating, 

medical staff 

revived the 

detainee and 

left! and the 

abuse 

continued." 

39. Physician lnterview BIT Sep 03- Baghdad Three requested episodes:l) to pretend to collect DNA with a hair sample; 2) to pretend to collect DNA sample with buccal swab; 3) 

was asked to #848 Aug 04 to provide cough syrup as a "truth drug". He refused #3, and prohibited medical personnel inclusion in any subsequent 

part~cipatein interrogations. Practice stopped 

interrogations 

three times 

40. Medical lnterview BIT Sep03- Northwest ff398 reports that he was used as an interpreter for interrogations under the direction of the S-2 because he is fluent in Arabic. 

personnel #398/#979 Sep04 Iraq #398 never acted as a medic during any interrogations, only acted as an interpreter. #979 (combat medic,(b)(W I who is 

involved with fluent in Arabic, reports that he served as interpreter for intelligence gathering. #979 asked his supervisor to limit the use of his 

interrogations language skills to care for detainees. Despite repeated requests. #979 was told by his medical OIC that he would continue to assist 

in intelligence gathering. 

41. Medical lnterview BIT Mar 03- Kirkuk #33, an LPN from(b)(W Ireported that he saw sedatives jativan, diazepam, etc.) being used by medical personnel to calm a 

personnel #33/#3611i1 Mar 04 detainee so that the detainee would talk more. #33 did not think it was aoorooriate. #33 reDorts that he was asked to do this. but 

providing 39/#1381#1 he did not do it himself. Several others in the unit (#36, 139. 138. 137, 32: 136, 63, and 62i were interviewed and none of them 

sedatives to a 37Iti321 reported similar requests or observations. None of them reported administering any medications to assist in the interrogation 

deta~neeso he #I 36/#631# process. The Team referred th~s incident to the chain of command after conferring with the CID Staff Judge Advocate. 

would talk more 62 

during 

interrogation 

42. Interrogation lnterview BIT Mar 03- Balad lnterview #I64 stated that "if the detainee or EPW was not picked up or claimed by the unit that brought them to us (could be MP or 

on ICW ward #I 64 Feb 04 maneuver unit) at the time of d~scharge, the S-3 cell under the authorization of the Commander released them. lnterrogators came 

to the ward to ask questions of detainees. I don't know who the interrogators were (MPs, MI. etc.). The detainees were taken to 

the end of the ICW to be questioned. There was a process in which the interrogator had to go to the 5-3 shop first. S-3 escorted 

the interrogator to the ward. I did receive verbal instructions on the procedure for interrogators entering our facility (my ward)." 

OIF - STAFFING . SHORTAGES . .. . .

43. Interrogators Interview Jan-05 1 Interrogators assigned to((b)i2)-2 lwere used as interpreters for the medical staff during the initial screening of detainees, g~ving 

used as #866//Visit 1 :iE:y 1 some interrogators access to all of the detainee's medical information. Discussed on-site by Team. 

interpreters 1 to DIF ;: Mar-Aug 1 Baghdad I The translators with the(W21-2 often worked with the interrogators in addition to serving as translators for medicai care. It could 

aeecal ;;;view create a set of conditions for distrust between providers and detainees. 

information 
-- 

45. lnadequate 

personnel 

Interview 

#631i#2611 

Various 

Locations 

Individual medical personnel from the units listed reported that the supply of interpreters strictly for medical purposes was 

inadequate. One individual reported that the interpreters used for medical purposes were the same as the ones used for 

resources -- #36/#7261# -(Iy(~irkuk)). One individual reported that they had to rely on other detainees to be interpreters (#726 - interpreters 259/#2371# ucca)). One individual re orted that they had to use the interrogators as interpreters because they were the only ones 

178 available to be mterpreters /#259 One individual reported concerns about the quality of the interpreters with 

concerns that one interpreter was found to be inappropriately touching patients and was fired and another was found to be sending 

intelligence to Kuwait for retaliation against the Iraqis (#261 {F~a~hdad). Another individual felt that havin Kuwaiti 

interpreters was inappropriate as they often talked down to the lraqi patients and were culturally insensitive ("460 

individual had concerns that the interpreter provided to them was not accurate in what he was conveying (#631 - Two other individuals noted a general lack of availability of interpreters (#237 #-#178 1-

(Mosul)). Founded. 

46. lnadequate Interview BIT Jul 03 1: ~h$ bN2G 4 1 btaskedto2'-2 with an ambulance and medical 

personnel #917 Mar 04 resupply support p"2!-2 lmission was to supplement slafing at Abu Ghraib #91! repofled that intially thdresources medic assisted the unit, but within a very short period of time the MP medics were not available to assist with sick call. 

rotated every 90 days, making it extremely difficult to provide any continuity in leadership. #917 relates that one rotating 

MP Bn surgeon spent his entire deployment traveling to accompl~sh the task of establishing a hospital. 

47. lnadequate lnterview BIT 2003- Baghdad, These five ind~viduals, assigned to CSHs, reported a concern that nurses and enlisted medical personnel were required to guard 

personnel #2401#1731 2004 Mosul, individual detainee patients or wards of detainee patients. Their concerns were for inappropriate use of medical resources and a 

res0u1-ces-- #I 76i#7161 Balad possible conflict of interest, respectively. 

medical #I 98 hospitals 

personnel doing 

guard duty 

OIF - RE-USE OF SUPPLIES 

48. Re-use of NY Times BIT Mar-Jul Abu Ghraib )1(2)-2 1 Regarding the scarcity of supplies, #916 stated that the medical chests had only 6.5 and 9 ET tubes and that 

chest tubes 04 Feb 05 they were missing sizes 7, 7.5 and 8. During the MASCAL, there were no sterile chest tubes left. He said he was offered what 

(Cit. 36)l appeared to be a bloody chest tube; it was rinsed in normal saline and used immediately. He also states that the article 

T~meMag misrepresents the care provided to detainees and that top quality care was delivered given the limited resources. #771 states 

07 Feb 05 disposable medical supplies were never re-used and he never observed a chest tube being pulled out of one patient and put in 

(Cit. 47). another patient. 

Interview 

#9 l6i#77 1 

49. Re-use of lnterview # BIT Mar 03- Baghdad #I69 reported that resources were available but observed sharing of needles and sharing of drugs for all lraqi patients. There was 

expendable I69 Feb 04 fear that medical supplies would be depleted. Assigned t$b1(2)-2 

medical supplies 

50. Re-use of lnterview BIT Mar 03- Baghdadi "Did not have policy on re-use of expendable medical supplies, but had direction that scope of care in Iraq would permit that, and 

supplies #634 Feb 04 Tikrit policy from higher HQ was to care for Iraqis based on local scope of care. Did Commander's Inquiry concerning the re-use of 

medical supplies and found the allegation was not substantiated." Assigned t&21-2 

51. Re-use of Interview BIT NOV 03- Baghdad "Had limited resources. Shared resources equally. Many disposable supplies reused." Because US and coalition forces were 

supplies #I97 Jan 04 evacuated quickly the reuse was mainly limited to the detainees. There was no policy on reuse for lraqi patients, it was just done 

because of a shortage of supplies. Assigned t o m 

52. Re-use of Interview BIT May 03- Baghdad While ass~gned to thqbK21-2 Ireused syringes with a new needle for Iraq1 personnel and detainees. 

supplies #I 24 Jul04 

53. Limited lnterview BIT Mar 03- Baghdad "Initially short on supplies. Reused gloves, needles, and syringes on detainees only because of shortage. Always reused on same 

resourceslre-use #316 Feb 04 patient. Did this for three months. As more supplies arrived, stopped the practice." 

of supplies 

54. Limited Interview BIT Jan-Jun Tallil Nurses issued one needle, one syringe, and one pair of gloves per day for mixing drugs, not for patient care. Assigned tdb''2k2 

resources1 re- #I 98 03 

use of supplies 

55. Re-use of Interview BIT Mar-Jun Tallil Air Reuse of expendable medical supplies for all patients. "We were only allowed to use one pair of gloves per day so we wouldn't run 

expendable #5ll 03 Base out." Attached tc#b~c2)~2 1 

medical suoolies 

1 
Olf - SUPPLY SHORTAGES 

56. Med lnterview BIT Jan 04- Mosul, # 775 (~ommander[W~? Istated that she "went to(b)(2)-2 for staff and resources, told to provide local scope of care for 

resources for #775 Jan 05 Tikrit, TF Iraqis, and to not call them EPWs because detainees did not have to recelve the same care per Geneva Conventions." 

detainees OASl S 

57. Shortage of NY Times BIT Jul 03-Jul Abu Ghraib #917 reported a three month lag from ordering to acquiring supplies. There were not enough test strips to monitor blood glucose 

medical supplies 04 Feb05 04 levels adequately. As a result, the therapeutic goai was limited to keeping blood glucoses in the 200-300 mgldl range. #705 

(Cit. 36)l reported that he did not have adequate supplies and personnel to manage detainee care. 

Time Mag 

07 Feb 05 b)(2)-2 101 Mar 04-July 04: #916 commented tha$rbhould have been better resourced. He stressed that 130 

(Cit. 47). patients were treated in six hours with the staff and supplies available during a MASCAL. 

Interviews 

#9 1 7/#7051 

#9 l6/#700 

58. Shortage of lnterview BIT Mar 03- Kirkuk #'I39 and #I37 reported that the maneuver unit Bde Commander required one patient to stay at the FST for 3 weeks for intelligence 

medical supplies #I 39, 137 Mar 04 reasons. The patient had significant injuries requiring a great deal of personnel and supply resources. #I33 and #I37 felt that this 

was an inappropriate use of FST resources, which were depleted due to holding patients at the FST longer than doctrinally 

described. #I39 and #I37 reported that a surgeon from the FST voiced his concerns directly w~th the Bde commander and the 

detainee was transferred to a CSH. 

59. Shortage of lnterview BIT Mar-May BlAP (HVD #I72 reported that initjally the facility did not have any clothing for the detainees. #I72 reported that he deployed with adequate 

medical supplies #I 72 03 facility) supplies, but ran out quickly and re-supply was not adequate until about June 2003. #172 reports getting into arguments with the 

ASMC Commander about the detainee population and that he ultimately threatened involving the ICRC to get the Company 

Commander to respond to his requests for the needed supplies. 

60. Shortage of Interview BIT Apr-Nov Bucca #95 (combat medi~/~)(')-~ Ireported that the MTOE for his unit's medical supplies was inadequate. #95 reported that the only 

med~calsupplies 03 medical supplies he was allowed to deploy with were those on the MTOE and included only his aid bag and no rnedicatrons (not 

even Tylenol). #95 felt the packing list for the aid bag was inadequate. #95 reported that he and the other medic in his unit were 

told by their company that they would always be with a hospital and have medical supplies provided to them in theater. #95 stated 

that he used all of the resources he had on the detainees and did not have enough for US soldiers at t~mes. Before Dec 2003, #95 

had to drive to Kuwait to pick up supplies for US soldiers and detainees. 

61. Shortage of lnterview BIT Mar 03- Balad #713 rated detainee medical supplies as poor to none. He received direct~ves to use resources on US soldiers first and only use 

medical supplies #713 Jul04 what was left over for detainees. He formally requested a separate source of supplies for detainees. He felt that as medics, they 

were put in an unfair position because they weren't given enough to care for both US soldiers and the detainees, and yet they were 

held accountable to the ICRC for the care given to the detainees. 

62. Shortage of lnterview BIT Jan-Jun Baghdad #683, assigned t47reported making specific requests t$b)(2)-2 \including specialized 01-thopedic and neurosurgical 

medical supplies #683 04 supplies, that would result in more definitive surgical results and shorter length of stay for detainees. (US soldiers with these 

surgical requirements were evacuated out of theater. which is why the CSH didn't deploy with these items initially.) He felt them 

:b)(2)-2 really did want to help, but that they possibly didn't know how to accomplish these special ately. these 

supplies were made available to them after a more experienced MSC Logistician was provided to t h e m 

63. Inadequate lnterview #692 reported there were detainees with maxillofacial injuries that required plates and screws that were not available. #692 

instrumentation #692 attempted to procure the items prior to and during deployment without success. However, the unit that followed did receive these 

to treat items. 

rnaxillofacial 

injuries 

64. Shortage of Interviews BIT Mar-Jun Baghdad, #XI Jo(2)-2and #708rb)02lreported that the medical re-supply system in theater was not adequate because the supply 

medical supplies #261/708 03 Kuwait routes would "go down." 

65. Shortage of Interview BIT Feb-May Objective Ethics committee of rb)(2)-2 /met to discuss if the unit should hold back supplies for US soldiers. The ethics committee decided 

medical supplies #770 RAMS all patients wouid get the same treatment and have equal access to resources. 
66. lnadequate Interview BIT Feb 03- Baghdad #773(medicalplanner,o(2)2 office) reported that he received no guidance from CFLCC or CENTCOM that addressed 

resources for #773 Feb 04 detainee medical care. Planning amlevel began in Apr 02. There was discussion and planning for detainee medical care 

detainee care but the terminology used was "displaced civilians"or 'EPW," and never the term "detainees." In going to the compressed 

deployment. #713 stated there was no time to get additional hospitals in theater. #773 reported that thdo(2)2intent was to 

evacuate the displaced civilians or EPWs back to Kuwa~t for medical care. #773 reported that, during the planning stages, it was 

not known that Iraqis would not be able to be taken out of Iraq. 

67. lnadequate lnterview BIT Apr 03- Camp #5120[2)-2/eported they had a shortage of medication for all of their patients. Including azithromycin and cold medications, 

medication #512 Apr 04 Scania and some medications specifically needed for detainees, including insulin and cardiac meds. 

supply for 

detainees 

68. Shortage of lnterview BIT Apr 03- Baghdad #293(W-2 stated that "some medical supplies were limited at our level. I trained my Soldiers to treat US Soldiers first. If 

medical supplies #293 Mar 04 supplies were available, then we treated all the same." 

69. Shortage of lnterview BIT Apr 03- BlAP #978 ((bI(2)-2 stated that medication supplies for diabetic and insulin-dependent diabetic patients was limited. #978 felt that the 

medlcal supplies #978 Apr 04 supporting MP units could not procure the necessary medications through logistic channels. 

Olf - DETAINEE ENVIRONMENT 

70. lnadequate Interview BIT Mar-Jun Tallil Air #511 (W)-2 reported that there were not enough blankets for the detainees at night in the ICW and that it was very cold there. 

detainee #5ll 03 Base #511 was not supplied with extra blankets despite requests. #511 suggested to "his COY that he was going to build a fire in the 

environment middle of the ICW to keep the patients warmer. He was told not to build a fire and blankets were then provided. 

71. lnadequate lnterview BIT Apr 03- Abu Ghraib #444 (combat medic'- reported that Abu Ghraib sanitation was poor and that, in addition, the food supply for the 

detainee #444 Apr 04 detainees was horrible. He found cockroaches in the food that was available for the detainees and he dumped it out himself so it 

environment could not be served to them and they were given MREs Instead. He stated that he reported his concerns directly to tfielM2)-2 

Bde Commander and complained about this constantly, but it never got better while he was there. He also reported having policies 

briefed to him about not giving medical care or appropriate food or sanitation to the detainees. He stated that he and the other 

medic from his unit did not follow these uolicies and that he was forrnallv reurimanded at least five times as a result. He reported . . issue to(M2)-2 Bde Commander dlrecily. no actlons taken 

Olf - POTENTIAL ABUSES-BY USiCOALlTlON FORCES 

72. Performing Interviews Camp A dead lraqi was brought to thel(b)(2)-? aid station. He was placed in a body bag and removed from the aid station. A physician 

medical #21#704/ Ramadi went out to view the body and performed a cricothyroidotomy, inserted a tube, and instructed medics on how to perform the 

procedure on #701/#249 procedure. 15-6 was done. The physician received a GO letter of reprimand. This incident was referred by the Team to CID. 

dead lraqi /#642 and 

soldier Team 

mem ber 

telecon with 

CDR,(b)[2)-2 

w-2 

18 Mar 05 

73. Criminal NY Times BIT Jul 03- Abu Ghraib #705 p)(2)-2 stated he never directed the MPs to use a leash. #705 felt that he ran out of options to control a mentally 

detainee on a 04 Feb 05 Mar 04 unstable criminal detainee. He pursued transfer to the I

b)(2)~2 and to a civilian lraqi hospital with mental health services, but both 

leash (Cit. 36)i refused. #705 determined that the only remaining option was o apply a belt around his abdomen as a temporary measure. The 

Time Mag belt ended up around his neck. #705 does not how this happened. The detainee was being restrained for throwing feces and self07 Feb 05 mutiiation. #705 worked with the NCOIC of jb)(2)-2to order a harness, but could not locate one in the automated supply 

(Cit. 47). system. #917 stated restraint was applied only to one other detainee for the purpose of administering IV fluids. #917 reported that 

/Interview the MPs did not use restraints because it required additional personnel to monitor. #705 stated that he was misrepresented in the 

#7051#917i New York Times article. 

#974 
74. Beating of 

an lraqi born 

American by 

Special Forces 

when he stood in 

the way to 

prevent the rape 

of a local lraqi 

girl. 

75. Abuse of a 

detainee by MP 

76. Detainee 

with burns 

77. Detainee 

death 

78. Detainee 

abuse 

79. Detainees 

with burns 

80. Abuseof a 

detainee by US 

soldiers 

Interview 

#695 

lnterview 

#695 

Interview 

#734 

-

-

lnterview 

#475 

Interview 

#458 

Interview # 

172/#206/# 

209/# 634 

and(b)(2)-2 1 

b)!2)2I 

Medical 

Record 

Review 

(Detainee 

register # 

00 13753, 

#0015835) 

Interview 

#80 

BIT Jul-Oct 03 

B/T Jan-Mar 

04 

BIT Jun 03- 

Mar 04 

BIT Jun-Oct 

04 

B/T Mar-Aug 

03 

BlAP 

BlAP 

Abu Ghraib 

Baladl 

Mosul 

Balad 

Camp 

Cropper 

Bucca 

#695 recalls an incident that was described to him by an Iraqi-born Amerlcan citizen on a mission wlth the Special Forces. He 

stated the Special Forces attempted to rape a iocal lraqi giri. When the Iraqi-born American cltizen stood in the way, he was beaten 

and presented to #695 for treatment. #695 reported this incident to CID for investigation. 

A material witness, kept as a detainee for h~s own protection, was used as an interpreter. He was handcuffed and dragged to a 

transportation vehicle by an MP. When another interpreter appeared, the MP denied the abuse. The interviewee reported the 

incident to CID for investigation. 

#734 documented injuries consistent with abuse (cigarette burns) during initial screening of a detainee. As he had early access to 

the detainee upon arrival to the facility, #734 felt the abuse must have been done by the capturing unit. #734 submitted 

photographs and sworn statements to the Abu Ghraib CID. #734 was told by Abu Ghraib CID that if incidents occurred outside of 

Abu Ghraib it was not in their jurisdiction and the reports would be passed on to a higher level of CID whenever that other CID unit 

passed thru Abu Ghraib. #734 felt this was inadequate and went to the FOB Commander for guidance. The FOB Commander and 

#734 decided to turn these reports over to CID, ICRC, and the Coalition Provisional Authority to ensure they would be investigated 

fully. 

#475 had to report a potential detainee abuse case to CID three times before it was fully investigated. Ultimately. a soldier was 

arrested for the abuse incident 

#458 reported that an "MP on ward was found guilty of abuse and demoted." 

#I72 saw many injuries that he suspected were from abuse. He reported each of these, officially. to CID and to the Warrant Officer 

who was designated to receive abuse allegations. The reports he submitted included two patients with burns on their buttocks from 

being transported in a High Mobility Multl-Wheeled Vehicle (HMMWV) while seated on a hot surface. In reviewing the medical 

records from thd-1 $172 documented his findings, his concern for abuse, and his contacting CID (register #-and in 

his interview he states he reported register #I(b)(7)(W as weii). 

#80 stated that a detainee reported he was dragged by chains around the compound by a HMMWV. #80 involved his supervising 

physician, who documented a history and physical exam and took a sworn statement. #80 reported that this physician reported the 

incident up the chain of command. 

81. Detainee 

abuse 

82. Detanee 

with multiple 

brulses 

83. Possible 

detainee abuse 

84. Detanee 

found 

unresponslve 

85. Detainee 

"kidnapped from 

FST MI 

Interview 

#221 

Interview 

#385i#386 

lnterv~ew 

#765 

lnterview 

#246 

Interview 

#246 

BIT Aua 03- 

Apr 04 

B/T Jan -0ct 

04 

Spring 03 

Spring 03 

Fallujah. 

Fallujah 

Baghdad 

Baghdad 

Baghdad 

#221 recalled an incident that occurred after the hospital was bombed and two health care providers were killed. #221 reported that 

a medic got angry and h~t a detainee. This was handied by the medic's unit0(2)-2with formal counseling of the medic. 

Detainee had repeatedly attempted escape, had multiple bruises; 15-6 done, and charges unsubstantiated. 

#765 reported that a soldier was transporting a detalnee when a improvised explosive device exploded, injuring personnel In the 

HMMWV. The soldier got mad, went lo the back of the convoy and hit a detainee. This was reported to, and investigated by, CID. 

Patient in ketoacisosis, but MPs approached as if he were mereiy faking. Reported up chain of command and investigated; patient 

treated successfully for critical illness. 

Event reported up chain of command and investigated; patient returned and treated appropriately. 
Date of 

Incident! 

Allegation 

86. Detainee lnterview Spr~ng03 Baghdad Event reported up chain of command and investigated; patient hospitalized and treated 

beaten by MPs #246 

excessively after 

attempted 

escape from 

holding facility 

87. Detainees lnterview BIT Mar 03- Baghdad One patient with bruises, another with burns. Chain of commandlClD notified 

with suspicious #209 Feb 04 

injuries 

88. Detainees lnterview B/T Mar 03- Baghdad Reported for investigation; confirmed with other interview and med records review. 

with burns #206 Feb 04 

89. Possible Interview B/T Mar 03- Baghdadi At theo(2)-2a detainee was brought in with suspected abuse gentleman came with abrasions to his lower iegs feet and 

detainee abuse #634 Feb 04 Tikrit ankles, consistent with being drug around It was reported by doctor, to DCCS, to med ClNC meet~ng (detainee camps and special 

ops, directing medical assets) at Mosul 

90. Detainee Interview BIT Mar 03- Baghdad Not clear if bru~ses related to point of capture but reported thru chain of command for mvestlgatlon 

DOA with #206 Feb 04 

multiple bruises 

91. Detainee lnterview BIT May 03- Baghdad Reported thru chain of command to CID. 

with multiple #581 Jul04 

bruises including 

boot print to 

axilla 

92. Detainee lnterview BIT Jan 04- Mosul, #775 referred three cases to CID. "I met with CID Commander and was informed that all the cases had been investigated." 

abuse #775 Jan 05 Tikrit, TF 

OASl S 

93. Deta~nees Interview BIT Jan-Aug In vicinity of Not reported by sold~er, who was assigned t~(~)(~)-~ ~eamreferred incident to CID. 

forced to stand #7 2 03 aid station. -

bound on 

blacktop all day 

They went hours 

without water. 

At least two 

fainted. 

94. Detainee Interview BIT May-Jun Baghdadi Reported to COC. A Platoon Leader, assigned to(b)(2'-2 left the detainee handcuffed for at least five hours in an awkward 

handcuffed to a #545 03 Najef position; detainee became ill. Piatoon Leader was subsequently reprimanded and apologized to the patrol. 

vehicle steering 

wheel 

95. Detainee lnterview BIT Jan-Jun Camp Psychotic detainees were being held in Connexes in 130 degree temperatures, lying in own urine and feces. Reported to Camp 

abuse #470 03 Bucca Bucca Leadership; conditions corrected. 

96. Detainee Interview BIT May-Sep Camp Guards reported that MI personnel had placed handcuffed detainees outside in 120+ de ree temperatures for nine hours. Two 

Abuse #492 Victory detainees treated for heat njuries. Interviewee confronted MI First Sergeant, reported lfb)i2)' and sent written report 

to MP Battalion Commander. 

97. Possible Interview BIT Mar 03- Mosul Detainee with injuries not consistent with falling (guard's story), but with assault. Referred to CID. 

detainee abuse #715 Feb 04 

98. Detainee lnterview BIT Jan 04- Unknown US Soldier injured in convoy ambush hit a detainee. Reported and investigated 

abuse #625 Jan 05 

99. Possible lnterview BIT Jan-Jun Tallil Detainee had been very combative, and had attempted multiple escapes. Reported to chain of command: formal investigations 

detainee abuse #96 03 done. and not substantiated. 

100. Possible lnterview BIT Apr 03- Fallujah Detainee complained of abuse frequently; referred for investigation, and unsubstantiated. 

detainee abuse #380 Mav 04 
101. Possible 

abuse of Iraq1 

firefighter 

102. Detainee 

abuse 

103a. Possible 

detainee abuse 

103b. Detainee 

death 

104. Possible 

detainee abuse 

105. Detainee 

abuse 

106. Possible 

detainee abuse 

107. 

Documentation 

of preinterrogation 

screening in 

detainee record; 

detainees 

presenting with 

old injuries; MPs 

yelling at 

detainees 

108. Two cases 

of possible 

detainee abuse 

observed 

109. Detainees 

placed in metal 

guard shack 

1 10. Rumor of a 

soldier using a 

tazor on a 

detainee 

11 1. Physician 

refusing to treat 

a detainee. 

112. Detainees 

held in 

inappropriate 

environment 

Interview 

#380 

lnterview 

#38 

Interview 

#200 

Interview 

#ZOO 

Interview 

#549 

lnterview 

#572 

lnterview 

#788 

Interview 

#978 

lnterview 

#132/#133 

lnterview 

#5Y9 

Interview # 

850 

FaylJones 

report1 

lnterview 

#8971#9041 

e-mail 

correspond 

ence to 

Team 

Interview 

#574 

BIT Apr 03- 

May 04 

BIT May 03- 

Mar 04 

BIT Mar 03-

Feb 04 

BIT Mar 03-

Feb 04 

BIT Dec 03-

Jul04 

BIT May 03- 

Aug 04 

BIT Jan-Mar 

05 

BIT Apr 03- 

Apr 04 

BIT Apr-Dec 

03 

BIT May 03-

May 04 

BIT May 03-

Jul04 

BIT Jul 03 

Jul 04 

Fallujah 

Baghdad 

Mosul 

Mosul 

Baghdad 

Baghdad 

Abu Ghraib 

BlAP 

BlAP 

Baghdad 

Baghdad 

Abu Ghraib 

Baghdad 

Report of a Company Commander physically abusing an Iraqi firefighter; CID notified and investigated. 

Detainee reported abuse, investigated. "Commander relieved, appropriate action taken." 

One detainee brought in with broken jaw. Detainee said he was pushed, MP said he fell. This occurred as detainees were made to 

exercise, doing squats while wearing hoods. Once guidance was changed concerning detainee operations, stopped using loud 

music and prolonged standing activities. 

A detainee with diabetes and hypertension died. Did not do an autopsy. Death was investigated by CID. lnterviewee reported the 

investigation did not "show anything." 

Detainee reported abuse, did full exam and x-rays; investigated; abuse unfounded. 

Individual physically abused a detainee and he was chaptered out of the Army 

Detainee alleged abuse during interrogation; post-interrogation record did not reflect abuse reported at that time. Detainee brought 

to ER, CID notified; detainee retracted allegation. 

Assigned at HAP and worked at the DIF; prisoners would show up atp~~'.' with MP without 

coordination; felt that some of the MPs yelled at detainees and did not have a good understanding of cultural considerations; 

language barrier exacerbated the event. A number of detainees came in with ~njuries (approximately five days old); wounds were 

infected. #978 brought this up to the physicians. Physicians and medics would clarify the nature of the injuries through the 

interpreter (assigned wl MP). On two occasions, #978 questioned the nature of the injury to the MP. MP said facial injuries 

occurred from another Iraqi civilian. 

Documented in medical record, took pictures, and forwarded through chain of command for investigation. 

Observed detainees placed in guard shack that was very hot, handcuffed, with sandbag over the head. No injuries sustained by 

detainees. 

Reported as a rumor only; not mentioned in 61 other interviews with individuals from 

An MI soldier, in her testimony for the Fay /Jones report, stated that she found a detainee in his cell with a Foley catheter in place 

but without a collection bag attached. She stated that she contacted the physician on duty that night and he refused to see the 

patient or attend to her concerns. The Team contacted the MI Soldier to get more information about who this physician was. She 

did not remember his name, nor remember if he was a LTC or a COL, but stated that she could identify him in a picture if given one. 

The Team spoke to many medics and the few physicians that were working in Abu Ghraib around the time of this incident. The 

Team was not able to identify this physician. #970 does not meet the description and #706 re-deployed November 03, per email 

msg dated 25 Mar 05 to Team member. 

The detainees were held In a large pen w~thout cover, hands were bound, and 90% of the time they had sandbags over their heads. 

The detainees were not treated with dignity and respect. Sometrmes made to stand for two hours at a time. 
Olf - POTENTIAL ABUSES-BY IRAQlSllRAQl POLICE 

113. Sexual lnterview BIT Oct 03- Abu Ghraib An interpreter reported to #970, assigned tolib)(2)-2 that a detainee, believed to be a child detainee, had been sexually 

assault of a #970 Mar 04 assaulted by another prisoner. #970 reported it to the (b)(2)-2 commander, who investigated. #970 believes the criminal 

possible child detainee was drsciplined through the Iraq1 court system. Afterwards, no children were sent to Abu Ghraib. 

detainee (age 

unknown) by 

another prisoner 

114. Possible Interview BIT Jan 04- Baghdad #711; assigned t~(~)(~)-~ reported that the unit received assistance in the investigation of two episodes of alleged sodomy on 

sexual abuse of #7ll Jan 05 detainees. In both instances. the MP physician made the initial reports at the detention facility. This was reported to(b1(2)-2 

detainees and they contacted thel[b)(2)-2 to accept the patients in transfer for further evaluation. Both had colonoscop~es done to evaluate 

for physical findings that supported this allegation. CID was involved immediately to collect statements and medical records and 

investi ate this further. In a third episode, #711 was concerned about abuse and when he reported it. CID came three weeks later 

to thefrlto gather information for their investigation. 

1 15. Abuse of lnterview BIT Apr-Oct Northwest This physician reported that, at his BAS, they treated numerous detainees that had been phys~cally abused by the lraqi police. In 

detainees by #37 04 Iraq order to prevent this further, the US MPs took custody of the detainees after their medical treatment. 

Iraq1 police. 

116. Detainee Interview BIT Aug 03- Fallujah Investigated and found to be from other Iraqis. 

with bruises #385 Apr 04 

117. Detainee lnterview BIT Jan 04- Mosul CID notified: no adverse clinical outcome 

abused by other #8041#775 Jan 05 

Iraqis-SQ 

injections with 

gasoline 

118. Physical Interview Early 2005 Baghdad Chaln of command notified; practice stopped. 

abuse of a #816 

detainee by lraqi 

Army ata 

detention facility 

1 19. Sexual lnterview BIT Mar-Jun Balad Young detainee gang-raped twice in holding facility, second time after being returned to same area. MPs had no guards assigned 

assault of a W15 03 directly within the facility. Unclear if any actions taken. 

young detainee 
Chapter 21 

Citations in the Report 

1. AMEDDC&S 91 W10 Lesson Plan - International Humanitarian Law and the 

AMEDDC&S Exportable Training Package -Ethics and Detainee Operations -

3. AMEDDC&S Email - Exportable Training Package -24 Mar 2005. 

4. AMEDDC&S PAD - Just-in-Time Deployment Training - 10 Apr 2004. 

5. AMEDDC&S PAD - Medical Documents in Combat and Contingency 

and Other Detainees - 1 Oct 19 

12. Bagram SOP, Annex W-I - Sep 2004. 

15. Church -Comprehensive Review of Department of Defense (DoD) 

lnterrogation Operations -date unknown. 

Civilian Internees, and Other Detained Personnel (EPWIDetainee Policy) -15 

18. CONOPS for DHT in Support of Military Intelligence lnterrogation Operations. 

19. DAlG -Detamee Operat~ons lnspect~on Report -21 Jul2004. 
on Body Cavity Searches and Exams for Detainees under DoD Control -Jan 

Detainees - 12 Aug 19 

-More Questions About the Catheter - 28 Mar 

rol Detained in Conjunction with Operation Enduring Freedom, 10 Apr 

Reporting Requirements - 8 Sep 2004. 

37. OIF Theater Detention Healthcare Policy -Jan 2005, with multiple appendices. 

38. Physicians for Human Rights -Examining Asylum Seekers. 

39. Ryder -Assessment of Detention and Corrections Operations in Iraq -6 Nov 

2003. 
40. Schlesinger -DoD Detention Operations Final Report -Aug 2004. 

Providers and Enemy Persons under U.S. Control, Detained in Conjunction with 

OEF - August 2002 

Control at US Naval Base, Guantanamo Bay, Cuba -Aug 2004. 

Military Police Brigade -24 Jan to 9 Mar 2004 

Healthcare" -Mar 2005. 

46 Task Force 134 Memorandum, SOP for Ensurmg Separat~on of Detent~on 

Operations Funct~ons -Feb 2005. 
Chapter 22 

Glossary of Terms 

ABBREVIATIONS 

AAR 

AC Active Component 

AIT Advanced Individual Training 

AKO Army Knowledge On-Line 

AMEDD Army Medical Department 

AMEDD C&S Army Medical Department Center and School 

AOC Area of Concentration 

AOR Area of Responsibility 

AR Army Regulation 

ASMB Area Support Medical Battalion 

ASMC Area Support Medical Company 

Annual Training 

BAS Battalion Aid Station 

Brigade 

BlAP Baghdad International Airport 

BIF Brigade lnternment Facility 

BNIBn Battalion 

BSCT Behavioral Science Consultation Team 

CENTCOM Central Command 

CF Coalition Forces 

CFLCC Combined Forces Land Component Command 

CI Civilian Internee 

CID Criminal Investigation Division 

CJTF Combined Joint Task Force 

CLS Combat Lifesaver 

COB Civilians on the Battlefield 

Cause of Death 

Concept of Operations 

Continental United States 

Coalition Provisional Authority 

CRC CONUS Replacement Center 

CSA Chief of Staff-Army 

CSC Combat Stress Control 

CSH Combat Support Hospital 

CSS Combat Service Support 

CTT Common Task Training 

C2 Command and Control 

D A Department of the Army 

DAlG Department of the Army Inspector General 

DHT Detainee Health Team 

DIF Division lnternment Facility 
DoD Department of Defense 

EFMB Expert Field Medical Badge 

EPW Enemy Prisoner of War 

EMEDS Expeditionary Medical Support 

EXSUM Executive Summary 

F H Field Hospital 

Field Manual 

FOB Forward Operating Base 

FORSCOM Forces Command 

FRAGO Fragmentary Order 

FSB Forward Support Battalion 

FST Forward Surgical Team -

FTX Field Training Exercise 

GH General Hos~ital 

GO General ~ffider 

GTMO Guantanamo Bay 

HA Health Affairs 

HQ Headquarters 

HVD High Value Detainee 

IAT Incidents and Allegations Table 

I AW In Accordance With 

ICRC International Committee of the Red Cross 

ICW Intermediate Care Ward 

IED Improvised Explosive Device 

IIR Internment/ Resettlement 

IT0 Iraqi Theater of Operations 

JAG Judge Advocate General Officer 

JlDC Joint lnterrogation and Debriefing Center 

JIG Joint lnterrogation Group 

JRTC Joint Readiness Training Center 

JTF Joint Task Force 

KIA Killed in Action 

LP- Lesson Plan 

LRMC Landstuhl Regional Medical Center 

LTP Leader Training Plan 

LZ Landing Zone 

MASCAL Mass Casualty 

MEDIMed Medical 

MEDCOM Medical Command 

METL Mission Essential Task List 

MEU Marine Expeditionary Unit 

.... Military Intelligence 

MNC-I Multi-National Corps-Iraq 

MNF-I Multi-National Forces-Iraq 

MOB Mobilization 
MOS 1 Military Occupational Specialty 

MP 1 Military Police 

MRE Meals Ready to Eat 

MSC Medical Service Corp 

MTF Medical Treatment Facilitv 

MUlC Mobilized Unit In-Processing Center 

NCOlC Noncommissioned Officer in Charae u 


NG National Guard 

NTC National Training Center 

OBC Officer Basic Course 

OC 

OEF 

OGA Other Government Agency (can refer to CIA, FBI, etc) 

OIC Officer in Charge 

OIF O~eration lraai Freedom 

OPFOR opposing ~ories 

OPORDER O~erationOrder 

OTC Over the counter 

PA Physician Assistant 

PAD Patient Administration Division 

PASBA Patient Administration Systems and Biostatistics Activity 

POI Program of Instruction 

PPP Power Projection Platform 

PUC Person Under Control 

RC Reserve Component (Army Reserve or National Guard) 

RIP Relief in Place 

ROC Rules of Care 

Rules of Engagement 

Retained Personnel 

SD Security Detainee 

SDARNG South Dakota Army National Guard 

SECDEF Secretary of Defense 

-

SME Subject Matter Expert 

SOC Special Operations Command (can refer to SF, Delta Force, etc) 

SOP Standard Operating Procedure 

SOUTHCOM Southern Command 

STARTEX Start of Exercise 

TACSOP Tactical Standard Operating Procedure 

TB Tuberculosis 

-

TDA Table of Distribution and Allowances 

-

TF Task Force 

TIF Theater Internment Facility 

TOA Transfer of Authority 

TOE Table of Organization and Equipment 

TSG The Surgeon General (refers to the Army Surgeon General) 
TTP Tactics, Techniques and Procedures 

USARCENT US Army Central Command 

USARSO US Army South 

VTC Video Training Conference 

xo Executive Officer 

PHRASES TERM 

Abu Ghraib Detention facility located near Baghdad. Site of abuse scandal 

involving MP and MI personnel. currently houses a Level Ill 

detention medical facility. Has a large detainee population. There 

is variety in the spelling of this location in the documents cited. 

The Team, for uniformity purposes, has decided on the spelling 

listed. 

Abuse FayIJones EXSUM page 3 -Treatment of detainees that violated 

U.S. criminal law or international law that was inhumane or 

coercive without lawful justification. 

AMEDD Center Headquartered at Ft Sam Houston, TX, it is the location where the 

and School vast majority of medical training in the Army takes place. It is 

responsible for Career Management Field 91 (Health Services) 

schools. It is the site of advanced training for Medical Officers and 

Medical NCOs. Also trains many members from the other 

services. 

Army Regulation titled Enemy Prisoners of War, Retained 

Personnel, Civilian Internees and Other Internees, dated 1 

October 1997. 

Bagram Holding Largest holding area in the OEF theater. It is located at Bagram 

Area Air Base. For the purpose of this report it is considered a 

detention facility. 

Brigade Detention Detention facility run by a Brigade-level unit that serves as a 

Facility staging point for detainees before release or transfer to a DIF. 

Length of stay is very minimal. There are numerous BlFs in the 

OIF theater. 

Camp Bucca Largest of detention facilities. Houses a Level Ill detention 

medical facility. 

Camp Cropper Detention Facility located at BIAP. Houses a Level II detention 

medical facility. 

Career Captains Course designed for commissioned officers with a medical AOC at 

Course the ILT-CPT level. Formally called the Officer Advanced Course. 

Chain of Succession of leadership from squad leader to President of the 

Command United States. 

Combat Life Saver Non-medical personnel trained to perform basic life saving 

procedures in emergency situations, 

CONUS Specific locations designed to prepare, assess and give final 

Replacement approval to individuals headed to units in a theater of operations. 

Centers (CRC) The two stateside CRCs are located at Ft Bliss and Ft Benning. 
Detainee 1 Term used for any person under USICoalition control in the three 

theaters highlightid in this report. Includes enemy prisoners of 

war, civilian internees, retained personnel, high value detainees, 

security detainees and persons under control. 

Detainee Care Medical care given to any persons under USICoalition custody. 

Detainee Any medical personnel who provided medical care to at least one 

Caregiver detainee during their tour in theater (OEF, GTMO, OIF). 

Detainee Medical Medical documentation of inpatient and outpatient treatment and 

Records care given to personnel under USICoalition control. 

Detention Facility Refers to any area where a detainee is maintained, processed, 

interrogated or all of the above. This report focuses on divisionlevel detention facilities and above. 

Division Detention facility located in theater that serves as a staging point 

Internment Facility for detainees before release or transfer to a fixed prison facility. 

Time of stay for detainees is up to 21 days, 28 days with GO 

approval. 

15-6 Investigation Official investigation started at the direction of the unit, or higher, 

command. 

High Value Any detainee who may hold significant information on enemy 

Detainee operations in the OIFIOEF theater. Also refers to prominent 

members of the former Iraqi Regime. 

Home Station Military installation where a military member is stationed before 

mobilizing for deployment. 

Kandahar Holding Holding area located at Kandahar Air Base in the OEF theater. 

Area For the purpose of this report it is considered a detention facility. 

Levels of Medical Refers to the capabilities a medical unit has to perform medical 

Care services. Level I includes self-aid, buddy-aid, Combat Life Savers, 

Line Unit 91 Ws (Medical Specialists) and Battalion Aid Stations. 

Level II includes Forward Surgical Teams and Area Support 

Medical Battalions. Level Ill refers to Mobile Surgical Hospitals, 

Combat Support Hospitals, General Hospitals and Field Hospitals. 

Note that the levels of care of some units in the OEF and OIF 

theater significantly changed as resources and personnel were or 

were not available. 

Line Medic Medical Personnel assigned to a combat arms unit. These 

medical personnel accompany the combat arms soldiers on all 

missions in order to be able to perform emergency medicine. 

Maneuver Unit Combatant UnitICombat Arms Unit 

Medical Personnel Refers to all personnel who hold a medical MOS or AOC. 

Mobilization Occurs in phases, and refers to the actions taken to prepare and 

deploy a unit. 

MP Medic Medical personnel, usuallv a 91W, assinned to - an MP unit. 

91 G Army ~edical Records ~pecialist 

91 W Army Healthcare Specialist. Commonly referred to as a combat 

medic-~ 

Army Licensed Practical Nurse 
91X 1 Army Mental Health Specialist 

Officer Basic Initial training for commissioned officers with a medical AOC at the 

Course 2LT-CPT level. 

Operation Refers to actions in the Afghanistan region that began in 

Enduring Freedom December of 2001 and is currently ongoing. 

Operation Iraqi Refers to actions in the IraqIKuwait region that began in March 

Freedom 2003 and is currently ongoing. 

PASBA Designated as the repository for all detainee medical records from 

the OIF and OEF theater. 

Period of Service The time frame a unit or individual was deployed to a Theater of 

Operations. 

Point of Capture Initial place that a detainee is taken into USICoalition custody. 

Normally accomplished by a combat arms unit 

Power Projection Specific locations designed to prepare, assess and give final 

Platform (PPP) approval to the deployablility of units heading into the different 

theaters. 

Rules of Care Specific guidelines that detail the actions that medical personnel 

need to take in treating non-USICoalition troops in that theater. 

Often referred to as Medical Rules of Engagement (MROE). 

Southern Headquarters, located in Florida, that has command and control 

Command over Guantanamo Bay. 

S-2 The Security and Intelligence Cell of individual units. 

S-3 The Plans and Operations Cell of individual units. 

70E Refers to the AOC given to a Patient Administration Division 

officer. 

Task Force A grouping of units, or parts of units, brought together to perform a 

specific mission. 

Team (the) Refers to the Functional Assessment Team, the authors of this 

report. 

Theater An area of major operations by the US military. This report deals 

with the Afghanistan, IraqIKuwait and Guantanamo Bay theaters. 

Can also be referred to as a Theater of Operations. 

Training Centers Can refer to a number of military institutions involved in training 

soldiers. In CONUS, most commonly used to refer to the National 

Training Center and the Joint Readiness Training Center. 

USARSO The Army Service Component of the US Southern Command, 

headauartered in San Antonio. TX. 
SdBJECT Appoirrirnertl as Team Leader, Furicticfnai Assessn~enlTeam 

r d o Medical Training, 

mmrds. You wil! ass 

, if ta,whdrer they pioperiy 

.wiih raspxi: to rnedicaldy 

ill aka assess both the ao 

MOS;3BC.oUber sch.nol Irming urn; i~saning, pre- and postd.cjopEcymerct 

Irainlng and the zdcquacj of mciiicj;t operauons drzlctnne. Ym wli spscl6r~aliy 

detemne whether the Iraminr; cowed the procedures and pobi~irsSi?r maintaining 

medicat remds and for providing nledrcal Ireatmel?Lto POW$ and ather di;iia~nees 

2. Spccaficaily, ysu v:iN assess tno fobviain 

both ieaem component and actst%duty, p 

unit prwvide n~sdicaicars [e.g .MW, detaznecl facility. 

aeM rntcrrcygban hciYit,t)7 
I. Wi"clr rcsg6:;ct la thwe det~ntranFachaies that kept medical recards, did ime 

personnel yroperiy gsner Is, siare arm cnlii;ci appropsiale medical records of 

deLmces3 

xRiM A, Annex 1 25-2 
Caw OF war raq~iremenlsfor msdi 

Fn@eS. 

5'r'sjur ass?ssm@nln nol an in:.:~:~yI on Ft~bheryou ;ire tiiafi~rwunder the 

at!zhcr~:yi?[ Tnc. Surg~onG~PCE~ of :he Army Bo re**,e1vtttmltsrs l~ted in this

oppoiniment nrsm~rai~ditm and make re;omnend.a ~nl~l y, you are no 

'"n 1 ~ t:~ 1 :;i:qu!ren?enk of the procedures Wfa " -a-,+h-m for Functipnab USSBSSTVI~~~~ Team. 

Exhibit A, Annex 1 23-3 
Imrssan! General 

The Surgeon Genera! 

!bit A, Annex 'i 23-4 

a -he fotiowmg are hereby appc nkd as members lo the edicsl Tra~rring,aperations 

;in3 1 rcatncn" F~nrt~~nal hsws:;-eri Team. 

2 The team leailer exercises aulliwty aver your aCLWit% a5 a tram member 

k'oktf ;:,:j as ;P %?am rw~berfakes ;.+eced ncs a'%: a??qorrnal duties, 1DY, leav 

orfirs: act 2::~s 

- 3, 4 earn n7embcrs are su eel. to :he iv-nitalian~&elforth in 1Rc Rubs of inslruc60n Far 

Furctional Ar;sehsment Team. whlcn wi:I Ds disiri y t4e roam Isador, 
Exhibit A,Annex 3 23-6 

Chapter 24 - Exhibit B 

Functional Assessment Team Biosketches 

Rank 1 MG 

Name 1 Lester Martinez-Lopez 

BranchlMOS MC 

Current Duty USA Medical Research and Materiel Command, Ft Detrick, MD 

Assignment 1 

Brief History Mar 2002 -Present Commanding General, USAMRMC, FT Detrick, 

of Previous MD 

Assignments 

Jan 2000 -Mar 2002 Commanding General, USACHPPM, Aberdeen, 

MD 

Jun 1999 -Jan 2000 Command Surgeon, HQ USA FORSCOM, FT 

McPherson. GA 

May1 998 -Jun 1999 Commander, USA MEDDAC, FT Benning, GA 

Jun 1996 - May 1998 Commander, USA MEDDAC, FT Campbell, KY 

Jul 1994 - Jun1996 Commander, Combat Support Hospital 

FT Campbell, KY 

Jul 1990 -Jul 1994 Chief of Family Practice Service, USA MEDDAC 

FT Benning, GA 

Jun 1988 -Jul 1990 Division surgeon, Infantry Division, FT Carson, 

co 

Jul 1985 -Jun 1988 Dispensary Commander, MD DET GEN DlSP 

CP Walker, KS 

Jul 1983 - Jul 1985 Aerospace Medical Resident, STU DET AHS 

FT Sam Houston, TX 

Oct 1981 -Jul 1983 Flight Surgeon, Family Practice, USA HLTH 

CLN 

FT Belvior, VA 

Jul 1979 -Oct 1981 Family Practice Resident, USA MEDDAC 

FT Bragg, NC 

Jun 1978 -Jul 1979 Family Practice Intern, FT Bragg, NC 

Exhibit B 24-1 
Exhibit B 

Functional Assessment Team Biosketches 

Rank 1 Colonel 

Name (W-2 1 

BranchlMOS 1 Medical Service Corps I72C 

Current Duty Garrison C~mmander,P"~)~~ 

Assignment (W-2 

Brief History of 

Previous 

Assignments 

Aug 03 -Present 

Jul00 -Aug 03 

0(6)2 

Garrison C~mmander,(~)(~]~~ 

Deputy Commander, U.S. Army Medical 

Research and Materiel Command, Fort 

Detrick, Frederick, MD 21 702 

Chief of Staff, U.S. Army Medical 

Research and Materiel Command, Fort 

Detrick, Frederick, MD 21 702 

Jul96 -Aug 97 Executive Officer, Walter Reed Army 

Institute of Research, Walter Reed Army 

Medical Center, Washington, DC 20307 

May 93 -Jul96 Secretary of the General Staff, U.S. 

Army Medical Research and 

Development Command, Fort Detrick, 

Frederick, MD 21 702 

Assistant Director, Army Audiology and 

Speech Center, Walter Reed Army 

Medical Center, Washington, DC 20307 

Jul85 - Jun 90 Chief Audiology and Speech Pathology, 

Tripler Army Medical Center, Honolulu,HI 

Jun 82 - Jul85 

Chief Audiology Section, Fitzsimons 

Army Medical Center, Denver, Colorado 

Jan 81 -Dec 81 

Audiology Consultant US Army Medical 

Command Korea, Yong San Korea 

Jan 78 -Dec 80 

Center, Tacoma, Washington 

Audiologist, Madigan Army Medical 

Exhibit B 24-2 
Exhibit B 

Functional Assessment Team Biosketches 

Rank 

Name 

BranchlMOS 1 Medical Corps 161F9A 

Current Duty Staff Internist and Inten~ivist,~~"~'~~ 

Assignment Internal Medicine Consultant to the Army surgeon General 

Governor, Arm Chapter, American College of Physicians 7y, 

Brief History of Staff Internist, 'b'(6'-2 

Previous 

Assignments Army ACP Chapter Governor 

OTSG Internal Medicine Consultant 

Director of Medical Education, Womack Army 

Medical Center 

Chief, Dept of Medicine, Womack Army MEDCEN 

Chief, Dept of Medicine, US Army Hospital, 

Heidelberg 

Chief, Internal Medicine Service, Dewitt Army 

Community Hospital, Ft Beivoir, VA 

Staff Internist, Frankfurt Army Regional MEDCEN 

Advanced Course in Critical Care Medicine, LAMC 

Internship and Residency in Internal Medicine, 

Exhibit B 24-3 
Exhibit B 

Functional Assessment Team Biosketches 

Rank Colonel 

Name (bW2

BranchlMOS Army Nurse Corps I66Hl66E 

Current Duty Deputy Commander for Health Services, l'b"6)~2 

Assignment (bj(6)-2 

Brief History 2002-2004 Chief, Medical-Surgical Nursing Section, Brooke Army 

of Previous Medical Center, San Antonio, TX 

Assignments 

1999-2002 Chief, Medical Support Branch, Joint Readiness Clinical 

Advisory Board, Fort Detrick, MD 

Chief Nurse, lothCombat Support Hospital; deployed to 

Bosnia-Hergovina, Task Force Medical Eagle in support 

of Operation Joint Forge 

Chief, Perioperative Nursing Services, Fort Leonard 

Wood, MO 

Advisor to the Officer Advanced Course, AMEDD Center 

and School, Fort Sam Houston, TX 

Perioperative Nursing Educator and floor coordinator at 

Madigan Army Medical Center; assigned as FORSCOM 

nurse to the 47th Combat Support Hospital, Fort Lewis, 

WA 

Deployed as staff nurse and as an infection control 

officer with the 47th Combat Support Hospital; provided 

care to soldiers during Operation Desert Shield; unit 

reconfigured as a 24 bed hospital and followed the ~4'~ 

Infantry Division into Iraq 

Head Nurse, Ambulatory Surgery Center, Madigan Army 

Medical Center; assigned as FORSCOM nurse to the 

47" Combat Support Hospital, Fort Lewis, WA 

Operating Room Staff Nursellnfection Control Officer, 

Berlin, MEDDAC Berlin, West Germany 

Operating Room Staff Nurse, Madigan Army Medical 

Center 

Exhibit B 24-4 
Exhibit B 

Functional Assessment Team Biosketches 

Rank 1 LTC 

Name lrb'(6'-2 BranchlMOS 1 JAGl27A 

Current Duty 1 Staff Judge Advocate 

Assignment I= 

Brief History of Jul02 - Jun 03 

Previous 

Assignments 

Jul00 -Jun 02 

Jul98 - Jun 00 

Jul96 - Jun 98 

Jun95-Jun96 

Jul94 -May 95 

Jul94 -Jun 95 

Apr 91 -Jun 93 

Sep 90 - Mar 91 

Jan 88 -Aug 90 

Deputy Staff Judge Advocate, 

Ill Corps & Fort Hood, TX 

Chief, Administrative & Civil Law 

Ill Corps & Fort Hood, TX 

Executive Officer & Chief, Criminal Law 

U.S. Forces Korea & 8th Army 

Instructor 

Air Force Judge Advocate School 

Maxwell AFB. AL 

Chief, Criminal Law 

Fort Sill. OK 

JAG Graduate Course 

Charlottesville, VA 

Senior Defense Counsel 

Fort Sill, OK 

Chief, Legal Assistance, Trial Counsel, & 

Administrative Law Attorney 

10lSt& Fort Campbell, KY 

Brigade Legal Advisor 

Desert Shield IDesert Storm 

Chief, Claims, Legal Assistance Attorney 

Fort McClellan, AL 

Exhibit B 24-5 
Exhibit B 

Functional Assessment Team Biosketches 

Rank 

Name 

1 Major 

I

(W-2 USAR 

BranchlMOS ~Medical Corps I 61F 

Current Duty Program Director, Internal Medicine Residency Program, 

Assignment (b)(6)-2 

Brief History of Chief, Internal Medicine Service, Womack Army 

Previous 2003 Medical Center 

Assignments 1 2002 -- 2003 Staff Internist, Womack Army Medical Center 

2001 -- 2002 Clinical Assistant Professor of Medicine, 

University of Washington Medical School, 

Seattle, WA 

1998 -- 2002 Staff Internist, Adult Primary Care Clinic, 

Department of Medicine, Madigan Army Medical 

Center 

2000 -- 2002 Director, Intern Training and Assistant Program 

Director, Transitional Residency Program, 

Madigan Army Medical Center 

1999 -- 2000 PROFIS Field Surgeon, 296 FSB, Fort Lewis, WA 

I998 -- 1999 Chief, Medical Residents, Madigan Army Medical 

Center 

1995 -- 1998 Intern and Resident in Internal Medicine, 

Madiaan Armv Medical Center 

Exhibit B 24-6 
Exhibit B 

Functional Assessment Team Biosketches 

Rank 1 Master Sergeant 

Name 1 (W-2 

BranchlMOS 91W5H 

Current Duty Soldier Medic Trainincl Site NCOIC, (b"Gj 

Assignment b)(W 

Brief History of 

Previous 

Assignments 

Jan 04 -Present 

Feb 03 - Dec 03 

Current Assignment 

115'~ FH, Fort Polk, LA, 

Platoon SergeantIlEMT NCOIC (Deployed to 

OIF: March 03 -Jun 03 

Camp Arifijan, Kuwait) 

Nov 01 -Jan 03 565th Ground Ambulance Co, Ft Polk, LA 

Platoon Sergeant 

Sep 01 -Oct 01 ANCOC, Ft Sam Houston, TX 

Nov 98 -Aug 01 USAREC: Cary, NC Recruiting Station and 

Barstow, CA Recruiting Station 

Detailed Recruiter 

111lthACR, Ft Irwin, CA 

Medical Evacuation Section Sergeant 

United Nations Command Security Battalion, 

Joint Security Area, Camp Bonifas, Korea 

Medical Evacuation Section Sergeant 

May 95 -Sept 95 BNCOC, Ft Sam Houston, TX 

Jul94 -May 95 ?jthEngineer BN (C)(M) FLW, MO 

Medical Section Sergeant 

93rd Evacuation Hospital, Ft. Leonard Wood, 

MO 

Medical Specialist in MCW 

Dec 90 -Dec 91 296th FSB, Camp Edwards, Korea 

Aidman in Treatment section 

Jun 90 -Nov 90 IET and AIT 

Exhibit B 24-7 
Chapter 25 - Exhibit C, Annex 1 

Interview Script 

I have been appointed by The Surgeon General of the Army as a member of a medical 

assessment team. We have been tasked to look at medical operations in a deployed 

theater, pre-deployment training, in theater training, post-deployment training, and 

detainee medical care and documentation. This is an assessmentlevaluation, not an 

investigation. We are seeking input to improve future training and medical capabilities, 

as well as evaluating medical personnel's understanding of their obligations under Army 

regulations and international law. 

[If requested, show interviewee a copy of the team appointment letter] 

Although this is not an investigation, we are required to document the information 

obtained from our one-on-one interviews as official, sworn statements. 

I will be asking you to complete two documents. The first is a Privacy Act Statement. 

The second will be your official statement. The Privacy Act Statement explains the 

various uses for the information you provide me. Your statement will consist of answers 

to a standard set of questions and any additional information, not covered by the 

standard questions, that you provide me. We will also complete a questionnaire cover 

sheet. The cover sheet provides background information about your duty history and 

information about your unit. It is important that you provide me complete, honest 

answers to all questions. I again want to emphasize that this is an assessment, not an 

investigation. 

Prior to beginning the interview I will ask you to respond to some scenario questions. 

After completing the scenario questions ask -

Do you have any questions before we begin the interview? 

Exhibit C, Annex 1 25-1 
Exhibit C 

Interview Script 

INTERVIEW PROCEDURE 

1. Complete Privacy Act Statement. 

2. Complete background cover sheet. 

3. Complete questionnaire, ensure each page is reviewed and initialed. 

4. Ensure you have completed the information on the top of each page. 

5. Read the Affidavit portion on the last page word for word to the interviewee. 

6. Have the interviewee acknowledge that they understand the Affidavit. 

7. Have the interviewee sign the statement. 

8. Complete the date and location of the statement. 

9. Sign and print your name. 

10. Your authority to administer oaths is "Acting Adjutant." 

DA Form 3881 (If needed) 

On first line of Section A cross out "with the United States Army" and write in "a member 

of a medical assessment team." 

Exhibit C, Annex 1 25-2 
Chapter 25 - Exhibit C, Annex 2 

Questionnaire Cover Sheet 

~atcof interview L)L)-~I~I-YR 1 Location of Interview 1 

Interviewer 1 Rank of Interviewer MG COL LTC MAJ MSG 1 

INTERVIEWEE First Ramc 1 1 Wll Last Name 1 1 

Kank MOSIAOC 1 Gender Male bcmalc Age 1 

Years of Active Military Service \'ears of USARING Service 1 1 component A? RC NG 1 

llnit Name 1 1 Address 

CitylPost 1 1 State 1 1 zip 1 1 Yrs Assigned 

Phone No. 1 1 Unit Elnail 1 

Unit Co~nn~ander 

DEPLOYMENT HISTORY: 

Deployment Status Past Present Future N/A Level I 2 3 Theater GTMO OEF 01F 

Name of Cnit Deployed With: 

Specific Location of Cnit in Theater 

Theater Date of Arrival DL)-RIMM-YK 1 Theater Date of Departure DL)-MMI-YR 

Name of Medical OIC 1 

Kcassigned in I'heater? Y U If YES, Name of Unit .4ttached to 

Level 1 2 3 Name of Medical 01C 1 

Did jou rcceibc additional training at the net\ unit? YES YO 

Explain: 

Did your unit provide dctainee medical care in theatre? 1 YES NO 

If YES, 11hich unit? iu\e I~I,unll lor IIK ,~w\mm~ 

Did you provide detainee medical care in theatre? 1 YES NO 

MEDICAL DUTY: 

I MPMedic 1 9 i CSHDCCS 17 ASMC P.4 

2 Maneuver Medic 10 CSli DCA I8 ASMC Doctor 

3 AKMC .Medic I1 CIS13 Chief Nurse 19 Medical Co CO 

1 CSlI 9lW I2 CSIi Senior Clinical NCO 20 DIV SL~-yeon 

5 CSlI 91WM6 13 Manewer PA 21 BDE Surgeon 

6 Nurse I4 Maneti, er Doctor 22 BN Surgeon 

7 1 I CSII Doclor I IS I 1 MPPA 2.3 1 Denlist~Oral S~~rreon " 

I6 MP Doc 24 Administrative i 

26 Other: 25 Non-medical Leader 

Exhibit C, Annex 2 25-3 
Chapter 25 - Exhibit C, Annex 3 

Privacy Act Statement 

SUBJECT: Privacy Act Statement 

1. AUTHORITY: The authority for the collection of personal information during the 

conduct of this assessment is Title 10, United States Code, Section 3012 (10 USC 

3012). 

2. PRINCIPAL PURPOSE: The purpose for soliciting this information is to assist The 

Surgeon General in assessing Medical Training, operations and Treatment in OEF and 

OIF. 

3. ROUTINE USES: Any information you provide is disclosable to members of the 

Department of Defense (DoD) who have a need for the information in the performance 

of their duties. In addition, the information may be disclosed to government agencies 

outside of the DoD as follows: 

a. To members of the U.S. Department of Justice when necessary in the defense of 

litigation brought against the DoD, or against members of that department as a result of 

actions taken in their official capacity. 

b. To members of the U.S. Department of Justice when necessary for the further 

investigation of criminal misconduct. 

4. DISCLOSURE MANDATORY; THE EFFECT OF NOT PROVIDING INFORMATION: 

a. For individuals warned of their rights under Article 31, UCMJ, or the Fifth 

Amendment to the U.S. Constitution: 

"Providing the information is voluntary. There will be no adverse effect on you for 

not furnishing the information other than essential information which might not 

otherwise be available to the commander for his decision(s)in this matter." 

b. For individuals who may be ordered to testify: 

"Providing the information is mandatory. Failure to provide information could result 

in disciplinary or other adverse action against you under the UCMJ, Army 

Regulations, or Office of Personnel Management Regulations." 

Exhibit C. Annex 3 25-4 

Exhrbit C,Annex 4 25-6 



it C,Annex 4 25-9 

How cori>fortah'rcrd yo 








hibit G,Annex 8 

an Platfarm I GO US Replacement Center 

Dste: *- .-* 

PCK Xarne: 

PCW Uury Pnsii-icro: 

POC: 'lcfeptrorne P; , --"-

PGJr E~uuil: 

PEnthrm Lercntian: Bcmng, Rkrss, Llqy, Ompbcil Carw~.DIX,Dmm, Eustas, Wood. LCWF, McCoy 

I'olk. ltde~,Srll Szewa~n(circk oue] 





apBv 25 a Exhibit d, 

TC Questionnaire 

Chapter 26 -Exhibit D 

Summary of Recommendations 

The purpose of this Exhibit is to list all of the recommendations offered in this report. 

Some recommendations may be similar to others; however, all recommendations are 

included here. 

26-1. Question a. What units provided medical care to detainees in OEF and OIF 

and what was the period of service for each unit? 

None 

26-2. Question b. At what location did each unit provide medical care (e.g., MTF, 

detainee facility, and interrogation facility)? 

None 

26-3. Question c. What MOS and OBC training or other school training did the 

medical personnel serving in these units receive regarding the generation, 

storage and collection of detainee medical records and regarding the medical 

reporting of detainee abuse? 

a. Medical Records Training 

(1) AMEDDC&S should ensure standardization of training of detainee healthcare 

documentation and disposition of retired detainee records across the entire healthcare 

spectrum in all theaters, from the point of capture and collection point to the detention 

facilities. 

(2) Establish a team under the direction of the AMEDDC&S comprised of 

clinicians and PAD expertise with exceptional knowledge of the generation, storage, 

maintenance and collection (disposition) of detainee medical records from the point of 

capture and collection point to the detention facilities. The tasks and training content 

should be developed by this team. The AMEDDC&S should facilitate this process. 

(a) The above team should analyze courses' Pols and LPs to determine training 

gaps in the generation, storage and collection of detainee medical records. 

(b) The training should include a crosswalk of Geneva Conventions, DoD and DA 

regulations and policies pertaining to the generation, storage and collection of detainee 

medical records. Training content should be regularly revised to reflect changes in the 

policies. 

(c) The training structure should include all levels of care, from point of capture 

and collection point to the detention facilities. Training should incorporate ACIRC TDA 

and TOE medical units and medical assets in MP and maneuver units. 

Exhibit D 26-1 
(3) Create and deploy an exportable training package specific to the generation, 

storage and collection of detainee medical records for medical personnel in AC/RC TDA 

and TOE medical units. Medical assets assigned to AC/RC MP and maneuver units 

should receive the training package. 

(4) PAD officers and senior PAD specialists should serve as the subject matter 

experts and training resource for AC/RC level II and Ill units. The PA or senior 91W 

should serve as the training resource for non-medical units. 

(5) Incorporate training that is focused on the generation, storage and collection of 

detainee medical records into the 70E and 91 G courses. 

(6) Expand PAD "Just-in-Time Deployment Training" course to include deploying 

RC 70E and 91G personnel. 

(7) Develop sustainment and proficiency training for 70E and 91 G personnel in 

AC/RC units. Training and proficiency data for 70E and 91G personnel should be 

competency-based and reported regularly as part of the unit's readiness report. 

b. Detainee Abuse Training 

(1) Tools should be introduced to assist students in recalling their training; for 

example, a reference pocket training aid. The tool should display a decision algorithm 

to assist them in distinguishing actual or suspected abuse from injuries as a result of 

lawful combat operations. 

(2) AMEDDC&S, as the proponent for training of medical personnel in detainee 

healthcare care (to include medical reporting of detainee abuse) across the entire 

healthcare spectrum in theater, from the point of capture and collection point to a 

detention facility should: 

(a) Establish a SME team to develop the tasks and framework to build a 

comprehensive AMEDD training program. The framework should include all training 

platforms (MUIC, RTS, NTC, JRTC, and PPP) and methods of instruction (lecture, case 

studies, scenario, and AAR). The framework must encompass all levels of care, from 

point of capture to a detention facility. The framework must serve as an additional 

resource for TOE medical units and TDA facilities as part of the readiness component. 

(b) SME Team membership should include appropriate representation from the RC 

and should have exceptional knowledge of detainee care at the point of capture, 

collection point and detention facilities. Additionally, the team should be comprised of a 

judge advocate, a medical ethicist, and SMEs serving in the prison health care system. 

The tasks and training content should be standardized particularly in the professional 

development and MOS specific courses. 

Exhibit D 26-2 
(c) MOS-specific schools and professional development courses should 

incorporate case studies and scenario-based training on current Army operations. 

Training Centers, such as NTC and JRTC, should be provided with the means to 

provide realistic level I to level Ill detainee medical care training. 

(d) Consider using regularly scheduled video teleconferences with 91 W, 91WM6 

students and Soldiers that experienced detainee care from the point of capture, 

collection point or detention facility to enhance learning followed with a Q and A format. 

(e) Revise the existing exportable training package to include all tasks associated 

with detainee care. Incorporate selected incidents and allegations to serve as case 

studies or scenario play. The AMEDDC&S should facilitate development of the training 

package and push the products out. 

(3) MEDCOM should provide all medical senior leaders (ACIRC) detention care 

policies, regulations and references which could be accessed through the AKO site. 

MEDCOM should continually update AKO so that evolving guidance, tools and 

references are current. The following criteria and content (not all inclusive) should be 

considered: 

(a) Theater accessible. 

(b) Approved for continuing education credit. 

(c) Approved detention care competency tools. 

(d) DoD detention care guidance. 

(e) DA guidance relating to detention care. 

(f) "Health Professional's Guide to Medical and Psychological Evaluation of 

Torture by Physician for Human Rights" as an example (Cit. 38). 

(4) DoD-I 1322.24, Medical Readiness Training, 12 July 2002, (Cit. 21) should 

include detention care competencies. Competencies should be developed by SMEs 

possessing exceptional knowledge of detainee care at the point of capture, collection 

point and detention facilities and the prison health care system. 

Exhibit D 26-3 
26-4. Question d. Was there any policy guidance, OPORDER, SOP, or other 

authority establishing criteria for providing detainee medical support andlor care 

in the theater of operation? 

a. Although not required by law, DA guidance (DoD level is preferable) should 

standardize detainee medical operations for all theaters, should clearly establish that all 

detained individuals are treated to the same care standards as U.S. patients in the 

theater of operation, and require that all medical personnel are trained on this policy and 

evaluated for competency. Specific areas of guidance should include, but are not limited 

to: 

(1) Initial and continual screening assessments 

(2) Medical care equal to standards for U.S. Soldiers in the theater of operation 

(3) Informed consent 

(4) Protection of detainee medical information 

(5) Documentation in and handling of medical records 

(6) Recognition, documentation, and reporting of suspected abuses 

(7) Planning factors for medical resources required for detainee care 

b. All medical personnel must be trained on this guidance, with follow-up assessment 

of competency. 

c. Policies concerning detainee medical operations should be declassified to the 

greatest extent possible to allow for the widest application of recommendation (a) 

above. 

d. Classified policies should be archived on secure command web pages as they are 

updated or as new ones are added, since this will allow one to evaluate policy 

implementation timelines. 

e. Units having theater-level responsibilities (for examplevI, should propagate 

DA or DoD guidance, with particular emphasis on units delivering level I or II care in 

their AOR. 

26-5. Question e. What unit training did the active component receive prior to 

deployment regarding the generation, storage and collection of detainee medical 

records and the medical reporting of detainee abuse? 

a. Leaders at all levels should conduct meaningful training and verify by following up 

with an assessment via a competency test, regardless of the unit's deployment status. 

Exhibit D 26-4 
This training should be documented and archived. Training should be pertinent to and 

specifically address standard of care and the generation, storage and collection of 

detainee medical records as well as recognizing and reporting detainee abuse. 

b. Specific standardized training requirements should be given to all medical units, 

ACIRC prior to deploying to a theater of operation. Particular attention needs to be 

given to the training guidance given by the AMEDD to medical personnel assigned to 

level I and level II medical units. 

c. All medical units should assume they will have a detainee healthcare mission 

when deploying and identify it as a METL-training requirement. 

d. Develop pre-designated medical units specifically identified to serve in detention 

facility roles in future operations. These units can tailor their training, both predeploymentlpre-mobilization, as well as during deployment/mobilization, to this mission. 

Training should also focus on security procedures for medical personnel treating 

detainees and the physical and psychological stresses involved in detainee care. 

26-6. Question f. What training did reserve component soldiers receive at home 

station, power projection platforms and in-theater regarding the generation, 

storage and collection of detainee medical records and the medical reporting of 

detainee abuse? 

Same as 26-5 (Question e) 

22-7. Question g. Identify OEF and OIF detention medical facilities. 

None 

26-8. Question h. With respect to the detention medical facilities identified in 

subparagraph 2g immediately above, determine if the facility generated, stored 

and collected detainee medical records, to include records documenting medical 

support to any detainee being prepared for interrogation, being interrogated, or 

needing medical treatment as a result of, or immediately after, interrogation. 

a. Authorize medical personnel to halt any interrogation or interrogation technique if 

the detainee's health or welfare is endangered. 

b. Require interrogations to stop immediately if a detainee requires any medical 

treatment during the interrogation. 

c. Authorize medical personnel to perform pre- and/or post-interrogation medical 

evaluations at their discretion. 

d. Require pre- and/or post- interrogation medical evaluations be performed upon the 

request of an interrogator. 

Exhibit D 26-5 
e. Require all pre-, during, and post-interrogation medical care to be documented 

and included in the detainee medical records. 

f. Describe the process for documenting medical care delivered during or due to an 

interrogation. 

g. Describe the process to report and document in the medical record suspected 

abuse. 

h. Require medical personnel to be trained on the above recommendations, with 

follow-up assessment of competency to measure the effectiveness of training. 

26-9. Question i. With respect to those detention facilities that kept medical 

records, did medical personnel properly generate, store and collect appropriate 

medical records of detainees? 

a. DA guidance (DoD level is preferable) should: 

(1) Require that detainee medical records at facilities that deliver level Ill and 

higher care be generated in the same manner as records of U.S. patients in theater. 

(2) Address the appropriate location and duration of maintenance as well as the 

final disposition of detainee medical records at facilities that deliver level Ill or higher 

care. 

(3) Define appropriate generation, maintenance, storage, and final disposition of 

detainee medical records at units that deliver level I and II care. 

(4) Address the need for uniform documentation, to include accurate identification 

of all individuals entering information into all detainee medical records. 

(5) Clearly outline the rules for access to detainee medical records and provision 

of medical information to non-health care providers. The guidance should only permit 

release of detainee medical information to interrogators when needed to ensure the 

health and welfare of the detainee. 

(6) Training of medical personnel. All medical personnel should be trained on the 

above and evaluated for competency. 

b. DA guidance (DoD level is preferable) should: 

(1) Define who has access to detainee medical information and under what 

circumstances. 

Exhibit D 26-6 
(2) Require that all military personnel are trained on this policy and evaluated for 

competency. 

26-10. Question j. With respect to those detention facilities that kept detainee 

medical records, identify the location where the original and any copies of the 

records are maintained. 

See 26-9 (Question i). 

26-1 1. Question k. Were any medical personnel aware of, or treat injuries related 

to, actual or suspected detainee abuse? 

a. A DA definition of detainee abuse should be adopted (a DoD definition is 

preferable). 

b. At all levels of professional training medical personnel should receive instruction 

on the definition of detainee abuse and the requirement to document and report actual 

or suspected detainee abuse. 

c. Pocket cards be developed and distributed to all deploying medical personnel with 

"Medical Rules of Engagement" on the front and a training aid on detainee abuse on the 

back. 

26-12. Question I. Did any medical personnel aware of, or who treated actual or 

suspected detainee abuse properly document the abuse? 

a. A DA definition of detainee abuse be adopted (a DoD level definition is 

preferable). 

b. A DA standard requiring actual, alleged or suspected abuse be documented in a 

detainee's medical record (a DoD level standard is preferable). The standard should 

require: 

(1) Documentation of actual, alleged or suspected abuse in the detainee's medical 

record. 

(2) The medical provider's opinion if the medical evidence supports actual, alleged 

or suspected abuse; and 

(3) The action taken by medical personnel: 

(a) If the medical evidence fails to support the alleged abuse this fact should be 

noted in the detainee's medical record. 

(b) If the medical evidence is consistent with abuse, or is inconclusive, medical 

personnel must report the alleged or suspected abuse to the hospitalIMTF commander 

Exhibit D 26-7 
(MEDCOM SJA Information Paper-Health Care Professional Detainee Reporting 

Requirements-8 Sep 04) (Cit. 31). 

(c) A notation in the detainee's medical record that a report was made, when, and 

to whom. 

c. A DA standard detainee medical screening form should be developed and fielded 

(a DoD level standard is preferable). 

26-13. Question m. To whom did any medical personnel aware of, or who 

treated, detainee abuse, report such abuse? 

a. At all levels of professional training, medical personnel should receive instruction 

on the requirement to document and report actual or suspected detainee abuse. This 

training should include the definition and signs of actual or suspected detainee abuse. 

b. Scenario-based training on detecting detainee abuse should be developed and 

fielded at all PPPs, MUICs, and reserve medical training sites. All deploying medical 

personnel should receive this training prior to arrival in theater. 

c. All deploying medical personnel, prior to arrival in theater, should receive refresher 

training on the requirements and procedures to document and report actual or 

suspected detainee abuse. 

d. All individual and collective training for medical personnel (such as NTC, JRTC, 

Warfighters, and FTXs) should include reinforcing training on recognizing and reporting 

actual or suspected detainee abuse. 

e. Follow-on competency evaluations should be incorporated into all training 

guidance and plans. 

26-14. Question n. Were there any theater or unit policies or established 

SOPsITTPs that specifically required medical personnel to report detainee 

abuse? 

a. Clearly written standardized policies for documenting and reporting actual or 

suspected detainee abuse should exist at all levels of command (DoD, Army, 

Combatant Command, theater, and individual subordinate units). These policies must 

then receive command emphasis on a continuing basis. 

b. Medical planners at all levels should ensure clearly written standardized guidance 

is provided to medical personnel. This guidance should list possible indicators of abuse 

and contain concise instruction on how, and to whom medical personnel should 

document and report actual or suspected abuse. 

Exhibit D 26-8 
c. Develop DA level guidance (DoD level is preferable) on the procedures for 

processing allegations of abuse not supported by medical evidence. This guidance 

should contain clear instructions on how medical personnel should properly document 

allegations of abuse that are not further reported based on lack of medical evidence. 

26-15. Other Issues 

a. Overview of Site Visits to Afghanistan (OEF), Cuba (GTMO), and Iraq (OIF) 

(1) CFLCC guidance, regulations, and standards in relation to detainee 

healthcare, to OEF and OIF theaters, should be standard across the AOR, consistent 

with DoD guidance, and disseminated to the lowest levels. 

(2) Prior to the onset of operations, combat or humanitarian, dedicated translators 

must be embedded within level Ill healthcare units, for use by medical assets only. 

(3) OIF medical commanders should ensure medical assets are in place, and 

have a viable system to replenish them when necessary, at level I or II facilities that 

have significant detainee contact. 

(4) To ensure that medical information is protected, translators assisting medical 

personnel with detainee care should not assist interrogators who question the same 

detainees. 

b. OIF Theater Preparation for Detainee Care 

(1) The AMEDD should establish an experienced SME team to: 

(a) Comprehensively define the personnel, equipment and supply needs for 

detainee operations. 

(b) Develop a method to ensure a flexible delivery system for these special 

resources to the appropriate levels of care and for the entire timeline of future military 

operations. 

(2) Military planners need to assume that there is a high likelihood for detainee 

operations in all future conflicts and must allocate resources for detainee medical care 

in the planning process. 

c. Medical Screening and Sick Call at the DlFs and Prisons 

(1) DA guidance (DoD level is preferable) should require: 

(a) Initial medical screening examinations upon inprocessing to a detention facility. 

(b) Daily access to medical care for all detainees, 

Exhibit D 26-9 
(2) All military personnel must be trained on the above policy and demonstrate 

competency. 

(1) DA (DoD level is preferable) should standardize the use of restraints for 

detainees in units delivering medical care. The guidance should contain clear rules for 

security-based restraint versus medically-based restraint. Medical personnel must be 

trained on this guidance, with follow-up competency evaluations. 

(2) Use of restraints on any patient should be appropriately documented in the 

medical record. 

(3) All facilities providing level II or Ill care should be appropriately supplemented 

with MPs dedicated to provide detainee security. 

e. Medical Personnel Interactions with Interrogators 

(1) DA guidance (DoD level is preferable) should: 

(a) Prohibit all medical personnel from participating in interrogations.' This 

includes medical personnel with specialized language skills serving as translators. 

(b) Empower medical personnel to halt interrogations when any examination or 

treatment is required. 

(2) All military personnel should be trained on the above recommendations. 

(3) Scenario training is highly recommended 

(4) Follow-on competency evaluations should be incorporated into all training 

guidance and plans. 

e. Medical Personnel Photographing Detainees 

(1) DA guidance (DoD level is preferable) should: 

' For purposes of this recommendation the term "participating in interrogations" refers to the 

participation by medical personnel during an interrogation. For example, asking questions would be 

active participation. Medical personnel who assist in developing the plan of interrogation are not deemed 

to be "participating in an interrogation." Likewise, actual presence in the interrogation room may not 

constitute "participating in an interrogation." For example, personal observation by medical personnel to 

ensure the health and welfare of the detainee is not deemed to be "participation in the interrogation." 

Exhibit D 26-10 
(a) Authorize photographing detainee patients for the exclusive purpose of 

including these photos in medical records, and not require informed consent for 

photographs used in this manner (consistent with AR 40-66). 

(b) Mandate that photographs of detainees taken by medical personnel for other 

reasons, including future personal education material, research, or unit logs, must first 

have informed consent from the detainee. 

(2) Guidance for the above should be included in AR 190-8, which is currently 

under revision. 

e. The Use of Behavioral Science Consultation Teams (BSCT) in the Interrogation 

Process 

(1) DoD develop well-defined doctrine and policy for the use of BSCT 

(2) DA, (preferably DoD) policy should permit only BSCT personnel to participate 

in interrogation planning. 

(3) Psychiatrists/physicians should not be used in a BSCT role 

(4) All psychologists and behavioral health technicians serving in BSCT positions 

should receive structured training on the roles and responsibilities while functioning in 

this capacity. 

(5) MI personnel should clearly understand the defined roles, responsibilities and 

limitations of behavioral health personnel serving in a BSCT position. 

(6) All psychologists utilized as BSCT members should be senior, experienced 

personnel. 

g. Stress on Medical Personnel Providing Detainee Medical Care 

(1) MEDCOM should establish an experienced SME Team comprised of a 

psychiatrist, a psychologist, clinical representation from all levels of care and include 

representation from a Chaplain. The team should: 

(a) Comprehensively define the training requirements for medical personnel for 

inclusion into their pre-deployment preparation. 

(b) Consider revising CSC doctrine to effectively deliver support to medical 

personnel in theater. 

(c) Develop an effective system to regularly monitor post deployment stress. 

Exhibit D 26-1 1 
(d) Refine leadership competencies to assess, monitor and identify coping 

strategies of medical personnel in a warfare environment. 

(2) AMEDDC&S should develop the training content defined by the above team. 

The above team should approve the content. The training (not all inclusive) should 

include ethical dilemmas medical personnel face and the emotional aspects in providing 

care to insurgents and detainees. 

(3) MEDCOM should assure post deployment mental health assessment of 

medical personnel and provide follow-up care. 

26-16. Non-AMEDD Training 

a. Joint Readiness Training Center (JRTC) (recommendations offered by JRTC 

personnel, not the Team) 

(1) Establish a SME team comprised of expertise from clinicians to develop the 

tasks and framework to formalize the training program. The framework should 

encompass all levels of care, from point of capture to care in the detention facility. 

(2) The above team should assess the current training, specifically the scenarios 

to determine training deficiencies and determine the best practices in improving the 

quality of training as it relates to detainee medical care. 

(3) Since AMEDD personnel must be prepared to provide care across the entire 

healthcare spectrum in theater, from the point of capture and collection point to the 

prison facilities, the training content should be developed by medical personnel with 

exceptional knowledge of detainee care. Additionally, the team should be comprised of 

representation from JAG, a medical ethicist, and subject matter experts serving in the 

prison health care system. The team members should develop the content and the 

JRTC medical OCs should facilitate. 

(4) Team membership should include representation from the NG and USAR 

personnel that served in these facilities as well as the active component. 

(5) The training should include a crosswalk of DoD and DA regulations and 

policies pertaining to detainee medical care. Training content should be revised 

regularly to reflect changes in the policies. 

(6) Define competencies for OCs. Ensure OCs are from every component 

b. National Training Center (NTC) (recommendations offered by NTC personnel, not 

the Team) 

(1) Add a detainee medical operations specific task to the EFMB task list 

Exhibit D 26-12 
(2) Add detainee medical operations into CLS training -the true first interface 

between the fighting force medical provider and the detainee. 

(3) Commanders need to incorporate detainee medical operations into the METL. 

c. Power Projection Platforms (PPPs) 

(1) PPPs need to ensure medical personnel deploying are able to use their time at 

the training site to prepare for their upcoming mission. They should not be tasked with 

non-training missions (such as providing routine medical care) unless a quantifiable 

training effect can be assessed from such medical care. 

(2) PPPs need to make their training "theater-specific" to ensure Soldiers 

processing through are adequately informed of any unique theater challenges or 

dangers. 

(3) Geneva ConventionILaw of War training needs to be improved upon by 

reflecting current rules of engagement and ethical challenges facing Soldiers. 

Emphasis needs to be placed on reporting suspected or actual abuse. 

(4) Units should still bear the responsibility of training Soldiers on detainee 

medical records. 

d. CONUS Replacement Centers (CRC) 

(1) CRCs need to look at opportunities to expand current detainee operations 

training to include more comprehensive teachings on reporting suspected or actual 

detainee abuse. 

(2) Geneva ConventionILaw of War training needs to be improved upon by 

reflecting current rules of engagement and ethical challenges facing Soldiers and use a 

scenario based component to enhance learning modalities. It needs to emphasize 

reporting suspected or actual abuse 

(3) Units should still bear the responsibility of training Soldiers on detainee 

medical records. 

e. Military Intelligence 

DA, or preferably DoD, should exercise oversight in the revision of current interrogation 

training doctrine to ensure compatibility with the Geneva Conventions, the Law of War, 

and all policies that apply to medical personnel. 

Exhibit D 26-13 
Chapter 27 - Exhibit E 

References Reviewed by the Medical Functional Assessment Team 

1 Reference 

1 ACLU DOCUMENTS 

1 CID Responsive Documents to ACLU Request 

1 CID ACLU DOC lndex Spreadsheet 

1 CSD ACLU DOC lndex spreadsheet 

1 MEDCOM Consolidated ACLU DOC lndex Spreadsheet 

PASBA ACLU DOC lndex Spreadsheet (OEF-OIF Internees) 

Proponency Office ACLU DOC lndex Spreadsheet 

POLICY & REGULATORY 

AFl 41-210 Patient Administration 

AR 40-3 Medical, Dental, and Veterinary Care - 12 Nov 02 

AR 40-5 Preventive Medicine - 15 Oct 90 

AR 40-66 Medical Record Administration and Health Care Documentation -20 Jul 04 

1 AR 40-400 Patient Administration - 12 Mar 01 

1 AR 190-8 Enemy Prisoner of War, Retained Personnel, Civilian Internees, and other 1 Detainees - 1 Oct 97 

1 AR 190-47 The Armv Corrections Svstem -5 Aor 04 

AR 350-1 Army ~raihn~ &ducatiok-9 Apr 03 

1 CJCSl 3290.01A Program for Enemy Prisoners of War, Retained Personnel, Civilian 

Internees, and Other Detained Personnel - 15 Oct 00 

CJCSl 5810.01 B Implementation of the DoD Law of War Program -25 Mar 02 

DA PAM 27-1 Treaties Governing Land Warfare -7 Dec 56 

DA PAM 27-24 Selected International Agreements, Volume II - 1 Dec 76 

DoD Directive 2310.1 DoD Enemy POW Detainee Program - 18 Aug 94 

DoD Directive 5100.77 DoD Law of War Program -9 Dec 98 

DoD Instruction 1322.24 Medical Readiness Training -12 Jul 02 

DoD 6025.18-R DoD Health Information Privacy Regulation -Jan 03 

FM 3-19.1 (FM 19-1) Military Police Operations -22 Mar 01 

FM 3-19.40 (FM 19-40) Military Police Internment Resettlement Operations - 1 Aug 01 

FM 4-02 (FM 8-1 0) Force Health Protection in a Global Environment - 13 Feb 03 

FM 4-02.4 (FM 8-10-4) Medical Platoon Leaders' Handbook -24 Aua 01 u 


FM 4-02.10 Theater Hospitalization -29 Dec 00 

FM 4-02.1 2 Health Service Support in Corps and Echelons Above Corps -2 Feb 04 

FM 4-02.1 7 Preventive Medicine Services -28 Aug 00 

1 FM 4-02.21 Division and Brigade Surgeon's Handbook - 15 Nov 00 

1 Geneva Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment 

or Punishment - 10 Dec 84 

Geneva Convention on the Condition of the Wounded and Sick in Armed Forces - 12 

Aug 49 

Geneva Convention Relative to the Protection of Civilian Persons in Time of War - 12 

Aug 49 

Geneva Convention Relative to the Treatment of Prisoners of War -12 Aua 49 

Exhibit E 27-1 
- - 

Protocol (Protocol I), Additional to the Geneva Conventions of 12 August 49, and relating 

to the Protection of Victims of lnternational Armed Conflicts - Adopted 8 Jun 77 

Hague Convention, Convention Respecting the Laws and Customs of War on Land - 18 

Oct 1907 

JP 3 Doctrine for Joint Operations -10 Sep 01 

JP 3-63 Joint Doctrine for Detainee Operations - Final Coordination Draft -23 Mar 05 

JP 4-06 Joint Tactics, Techniques, and Procedures for Mortuary Affairs in Joint 

Operations -28 Aug 96 

NAVMED P-117 Manual of the Medical Department, 23 Nov 94 - Reprinted 96 

18 U.S.C. !j 2441. War Crimes Act of 1996 (As Amended) 

PUBLIC DOMAIN 

American Medical Association's Code of Medical Ethics - 200212003 version 

1 Borden Institutes' Books Military Medical Ethics - Volumes I & 2 - 2003 

1 Vice Adm. Church's Com~rehensive Review of De~artment of Defense (DoD) ' 

Interrogation Operations (complete Report and ~xecutive Summary) 

Department of the Army Inspector General's (DAIG) Detainee Operations Inspection 

Report - 21 Jul04 

DoD Book Emeraencv War Suraerv, 3rd Ed, 2004 

MG Fay and LTG Jones Article 15-6 Investigation of the Abu Ghraib Prison and 

205th Military Intelligence Brigade -Feb 04 

lnternational Committee of the Red Cross (ICRC) Report on the Treatment by Coalition 

Forces of Prisoners of War and Other Protected Persons by the Geneva Conventions in 

lraa durina Arrest. Internment. and lnterroaation - Feb 04 

international corrkctions and Prisons Association's (ICPA) Book Practical Guidelines For 

the Establishment of Correctional Services Within United Nations Peace Operations - 01 

1 BG Jacoby's Review of Detainee Operations and Facilities in Afghanistan -26 July 04 

1 Judae Advocate General's 

., 

School O~erational Law Handbook - 02

Judge Advocate General's School Law of War Workshop Deskbook - 00 

MG Ryder's Assessment of Detention and Corrections Operations in Iraq -6 Nov 03 

Mr. Schlesinger's DoD Detention Operations Final Report -Aug 04 

MG Taguba's Administrative lnvestigation of Alleged Detainee Abuse by the 800th 

Military Police Brigade, 24 JAN -9 Mar 04. 

MEDCOM [Patient Administration Systems & Biostatistics Activity's (PASBA)] 

Memorandum "Deployment Medical Documentation GuidanceIReporting Requirements" 

-12 Mar04 

Physician's for Human Rights'2001 Publication of "Examining Asylum Seekers -A Health 

Professional's Guide to Medical and Psychological Evaluations of Torture" -Aug 01 

Physician's for Human Rights' 2002 Publication of "Dual Loyalty & Human Rights In 

Health Professional Practice; Proposed Guidelines & Institutional Mechanisms" 

United Nations Publication of "Standard Minimum Rules for the Treatment of Prisoners' 

13 May 77 

United Nations Publication of "Principles of Medical Ethics Relevant to the Role of 

Healthcare Personnel, Particularly Physicians, in the Protection of Prisoners and 

Detainees Against Torture and other Cruel, Inhuman or Degrading Treatment or 

Punishment" - 18 Dec 82 

Exhibit E 27-2 
United Nations Publication of "Body of Principles for the Protection of All Persons under 

Any Form of Detention or Imprisonment" -9 Dec 88 

United Nations High Commissioner for Human Rights' Publication of "The Istanbul 

Protocol - Manual on the Effective lnvestiaation and Documentation of Torture and other 1 Cruel, Inhuman or Degrading Treatment & Punishment" - 9 Aug 99 

1 White House Press Release "President Issues Militarv Order -Detention. Treatment, and 1 Trial of Certain Non-Citizens in the War Against ~errdrism" - 13 Nov 01 ' 

1 White House Presidential Order Number 499 "Humane Treatment of Al Qaeda and 

1 Taliban Detainees" -7 Feb 02 

World Medical Association's (WMA) "Resolution on the Responsibility of Physicians in the 

Denunciation of Acts of Torture or Cruel or Inhuman or Degrading Treatment of Which 

They Are Aware" -Sep 03 

1 MEDIA COVERAGE 

1 American Forces Press Service (Gilmore) "Medical Personnel Didn't Commit Widespread 

1 Detainee Abuse, Say DoD" -1 I Feb 05 

1 Army Times (Funk) "No Proof Found That Medics Took Part In Abuse, Torture" -10 Feb 

05 

Associated Press (Ross) "Professor Accuses Doctors in lraa Abuse" -20 Aua- 04 

Boston Globe (sa"age) ''probe Leaves Out EX-~ommander'~t Guantanamo" - 25 Feb 0 

Boston Globe (Bender) "Higher General To Probe Alleged Abuse" - 1 Mar 05 

CBS (AP) "Docs Complicit In Prison Abuse?" -20 Aug 04 

CBS (News Online) "U.S. military prisoner abuse inquiries" -23 Aug 04 

Chicago Sun Times (Higgins) "US Methods Criticized in Report on Guantanamo" - 1 Dec 

04 

City Journal (MacDonald) "How to Interrogate Terrorists" -Winter 05 

Hastings Center Report (Rubenstein, Gross, Verkerk) "Medical Ethics in War time" -

NovIDec 04 

Knight Ridder Newspapers (Allam) "Despite Improvements, Abu Ghraib Still Presents 

Challenges for New Commander" -22 Jan 05 

Lancet (Editorial) "How complicit are doctors in abuses of detainees?" - 21 Aug 04 

Lancet (Miles) "Abu Ghraib: its legacy for military medicine" - 21 Aug 04 

Lancet (Silove) Book Review: " Challenges in fighting torture: from September 11 to Abu 

Ghraib" - 5 Jun 04 

Miami Herald (Dodds) "Sexual Tactics Debased Detainees, Translator Says" - 28 Jan 05 

NEJM (Lifton) "Human Rights -Doctors and Torture" -29 Jul 04 

NEJM (Comments to Editor -including DoD response) RE: "Doctors and Torture" - 7 Oct 

04 

NEJM (Gawande) "Casualties of War - Military Care for the Wounded from lraq and 

Afghanistan" -9 Dec 04 

NEJM (Peoples, Jezior, Shriver) "Caring for the Wounded in lraq -A Photo Essay" -9 

Dec 04 

NEJM (Bloche & Marks) "When Doctors Go to War" -6 Jan 05 

New York Times (Zernike) "Only a Few Spoke Up on Abuse as Many Soldiers Stayed 

Silent" -22 May 04 

New York Times (Lewis) "Red Cross Finds Detainee Abuse In Guantanamo" -30 Nov 04 

Exhibit E 27-3 
New York Times (Bloche & Marks) "Triage At Abu Ghraib" -4 Feb 05 

New York Times (Schmitt) "New lnterrogation Rules Set For Detainees In Iraq" 10 Mar 05 

OSD PA0 Transcript of Church Briefing on Detention Operations and lnterrogation 

Techniques -10 Mar 05 

Seattle P.I. (AP) "Red Cross Sees Problems at Guantanamo" - 30 Nov 04 

Stars and Stripes (Coon) "Task Force Oasis brings medicine to Abu Ghraib -6 Jun 04 

Time Magazine (Zagorin) "The Abu Ghraib Scandal You Don't Know" -14 Feb 05 

USA Today (Squitieri & Moniz) "U.S. Army re-examines deaths of lraqi prisoners" -28 

Jun 04 

Washington Post (Slevin) "Detainees Medical Files Shared: Guantanamo Interrogators 

Access Criticized" -10 Jun 04 

Washington Post (Eggen & Smith) "FBI Agents Allege Abuse of Detainees at 

Guantanamo" - 21 Dec 04 

Washington Post (Smith & Eggen) "Justice Expands 'Torture' Definition" - 31 Dec 04 

Washington Post (Reuters Report) "CIA is Ordered to Release Detainee Abuse Files" -3 

Feb 05 

Washington Post (Xenakis) Letter to Editor "From Medics, Unhealthy Silencen- 6 Feb 05 

Washington Post (Kiley) Response to Xenakis "A Healthy Silence" 10 Feb 05 

Washington Post (Leonnig & Priest) "Detainees Accuse Female Interrogators" -10 Feb 

05 

Washington Post (Graham) "Prisoner Uprising In Iraq Exposes New Risk for U.S." - 21 

Feb 05 

Washington Post (Smith & White) "Soldier Who Reported Abuse Was Sent to 

1 psychiatrist" -5 Mar 05 

1 Washington Post (White & Smith) "Low-Level Leaders and Confusion Blamed" -10 Mar 

05 

Washington Post (White & Graham) "Senators Question Absence of Blame in Abuse 

Report" - 11 Mar 05 

Washington Post (Web Post) "Conditions at Guantanamo Bay: Defense Dept. 

Documents Detail Red Cross Comments on Detainee Treatment and Actions Taken in 

Response" - 18 Jun 04 

Washington Post "A Guantanamo Timeline" -4 Jan 05 

Weekly Standard (MacDonald) "Torturing The Evidence 

The truth about the doctors at Guantanamo" -24 Jan 05 

World Socialist Web Site (Randall) "Bush's 'Torture Inc.' at Guantanamo" -2 Dec 04 

TESTIMONY 

HASC Hearing on lraqi Prisoner Abuse - 7 May 04 

SASC Hearing on lraqi Prisoner Abuse -7 May 04 

1 SASC Hearing on lraqi Prisoner Abuse - Morning of 1 1 May 04 

1 SASC Hearina on lraai Prisoner Abuse -Afternoon 11 Mav 04 

SASC ~earing on lradi Prisoner Abuse -19 May 04 

1 TEAM RELATED 

1 Appointment as Team Leader, Functional Assessment Team -12 Nov 2004 

1 Appointment of Members to Functional Assessment Team -30 Nov 2004 1 CO~(~"~'-~mail Traffic "Mission and Objectives of the Behavioral Science Consultation 

Exhibit E 27-4 
With COL[~)(~)-~ - 21 Dec 04 

Email Traffic "Followup 

Email Traffic "Notes from Meeting with 

Phone Call" From 

1b)(6)-2 

COL 

a 

(b)(6)~2 4 Apr 

Email Traffic "Requested Lesson Plans" from Mr. 'b)(6)-2 

mb)(6)-2 (AMEDD C&S) - 16 Dec 04 

1 mail Traffic "Exportable Training Package" to ~ol'b"G'T 

1 C & S S 

I MAJ p)(6)-2 mail Traffic "More Questions about the Catheter" - 25 

1 Mar 05 

1 MCJA MFR (Assessment Team Guidance) - 12 Nov 04 

1 MCJA Rules of Instruction for Functional Assessment Team - Undated 

1 Medical Legal Reference Matrix -Developed by Team 7 Apr 05 

1 Team Summary of 28th CSH Medical Record Review -29 Dec 04 

1 Team Summary of Autopsy Case Reviews - 1 NOT READILY AVAILABLE 

-(b)(2) 2 "'"--

Detainee Handling and Detention C--"'+.a I,, - OjV)-i ~etaineePacket Checklist (blank) 

(b)(2)-2 

0(2)2

1 Detention Facility Assessment Form (Blank) 

Post OIF Operational AAR (Undated) 

(b)(2)~2 Intensive Care Unit (ICU) SOP "Care of 

PALI~I 1 Memorandum " Operation lraqi Freedom: Surgical 

Experience of the'b"2'~2 20 Oct 04 

(b)(2)-2 "OIF Lessons Learned" Briefing -26 Feb 05 

b)(2)-2 Memorandum (EPW Holding Facility Monthly Inspections) -

21 Sep 04 

(b)(2)-2 

(b)(2)~2 1 EPW Legal References 

(b~-2 ~JAOInformation Paper (Nutritional requirements for Iraqi enemy 

prisoners of war) - 10 Feb 03 

(b)(2)-2 JAO lnformation Paper (Authoritv to use public vehicles for I transportation of EPW~) - 15 Feb 03 

b)(2)~2 JAO lnformation Paper (Care of dead EPWs and civilian 

internees) -20 I-eb 03 

(b)(2)-2 1 JAO lnformation Paper (Use of Riot Control Agents against 

Enemy Prisoners of War) - 22 Feb 03 

bXW2 JAO lnformation Paper (Use of Enemy Prisoners of War for Labor 

and Services) -24 Feb 03 

b)(2)~2 Guidance (Use of Force for EPW Guards) (Undated) 

b)(2)-2 I~nclosure1 (!raining Requirements for OIF) to FRAGO 559 (Consolidated 1 Deployment Training Guidance) td(b)(2)-2 OPORD 03-02 (Phantom Victory) 

(b)(2)-2 9 1WM~Training Requirements Undated 

b)(2)-2 1 Tab G Clinical Training to ')-FY (b)(2'-2 05 Annual v 

trainina Guidance (Undated) 

Exhibit E 27-5 
fb)(2)-2 1 Baghdad Central Correctional Facility (BCCF) Memorandum 

"Standards of Conduct (Policv Letter 1 Y' -3 Jun 04 

~a~hdad kentral cbrrectiona~ Facility (BCCF) SOP 8 "SOP Scheduled 

Baghdad Central Correctional Facility (BCCF) SOP 21 "SOP 

Scheduled Sick Call (Cougar 1-2)" 3 Jun 04 

~~21~2 Baghdad Central Correctional Facility (BCCF) SOP 32 "SOP 

Scheduled Sick Call (Cougar 3)" 3 Jun 04 

b)(2)-2 Baghdad Central Correctional Facility (BCCF) Memorandum 

"Policv/Procedures Exceptions in Observance of Ramadan" -5 Oct 04 

fbW2 1 Detention Cell SOP - 1 Oct 99 

b)(z)-2 1 Memorandum "Interrogation Tactics and Treatment of Detainees" 1 (Undated)

b)(2)-2 r 

p)-2 , commander Memorandum "Lessons ~earned:P"~'~' l~rison 

HospitalABG, Iraq, Feb-Jul 04" 9 Mar 05 

b)(2)-2 commander Memorandum "Accomplishments of (b)f2)~2 Baghdad 

Central Detention Facility Hospital, ABG, Iraq, OIF 2" - 9 Mar 05 Ffb)f2)-2 Commander Memorandum " Requirements for level I Healthcare at an ArmyRun Detention Facility, Formulated to Comply with AR 190-8 and the Recommendations 

of ICRC Visits" -9 Mar 05 

(b)(2)~2 ~nnexQ (Medical Services) to (b)(2)~2 (EPWICI) TACSOP 

(Undated)

1 AMEDD IPT Detainee Medical Carellnformation Process Charter - 17 Jun 04 

AMEDD IPT Detainee Medical Care Final Report to Deputy Surgeon General of the Army 

-21 JuI 04 

AMEDD IPT Detainee Medical Care Dissenting email from ~r 'b"6)-2 - 14 JuI 04 

AMEDD IPT Detainee Medical Care Dissenting email from COL/~"~'~~ 

(y20 JuI04 

AMEDD IPT Detainee Medical Care Draft OTSGIMEDCOM Policy Memo xx-xxx -

"Medical care of detainees, prisoners of war, internees, and retained personnel" -XX Jul 

04 

1 AMEDD IPT Detainee Medical Care Briefing 22 Oct 04 Version 2 

Baghdad Central Correctional Facility (b)(2)-2 ~etaineeSuicide Prevention Plan 

(Undated) 

Baghdad Central Detention Facility Point Paper "Military Health Support to a Military 

Detention Facility" -25 Jan 04 

1 Baghdad Central Detention Facility Hospital ""Internee Health Care" -27 Jan 04 

1 Baghdad Central Detention Facility Hospital "Medical Processing Briefing" (Undated) 

1 Baghdad Central Detention Facility Hospital Layout and Task organization (Undated) 

1 Baghdad Central Detention Facility Hospital Memorandum "Restraints" - Feb 04 

Exhibit E 27-6 
1 Baghdad Central Detention Facility Hospital Memorandum "Care of Detainees" - Feb 04 

Baghdad Central Detention Facility Hospital Memorandum "Management and Evaluation 

of Suspected Sexual Assault Victims" - Mar 04 

1 Baghdad Central Detention Facility Hospital Memorandum "Suspected I Alleged Assault 

or Abuse" - Apr 04/Rev/Jun 04 

Baghdad Central Detention Facility Hospital Memorandum " Family Visitation & Detainee 

Mail" - 13 Jun 04 

Baghdad Central Detention Facility Hospital Memorandum "Patient Death" (Ver 1 - Apr 

04) 

Baghdad Central Detention Facility Hospital Memorandum "Patient Death" (Ver 2 

Rnvl.l~ . .-.. --In . , 04\

- 'I 

Camp Bucca, Iraq SOP (b)('j-' I (EPWICI)) - 1 Jun 04 

Camp Bucca Internment Facility Dental Clinic SOP p"2'-2 I - Mar 05 

Central Air Force Command's "Concept of Operations for Detainee Health Team in 

Support of Military Intelligence lnterrogation Operations" -23 Jan 04 

CFLCC Medical Rules Of Care - 12 Jan 03 

bjw2 Policy Memorandum #I 2 - Medical Rules of Eligibility" Detainee Operations 

(Undated) 

,b)(2'~2 CG Policy Memorandum 18 -Proper Conduct During Combat Operations -4 Mar 

04 

(b)(2'2 ~JAlnformation Paper - Scope of Medical Care Required for Security Detainees -

2 May 04 

lnformation Paper - Minimum Standards of Treatment Applied to Security 

+- Patient Records 

ibj(21~2 Bagram Holding Area (BHA) and Kandahar Holding Area (KHA) Detainee 

Medical Standing Operating Procedure (SOP) MFR - 14 Aug 04 

(b)(21-2 1 ~agramHolding Area SOP - 29 Sep 04 

1 Annex W-I (Medical) to (b)(21-2 I Baaram Holdina Area SOP 

Annex W-2 (~edicalj -Guarding and ?ransferringupucs Under the Care of The BHA 

Physician to 7Bagram Holding Area SOP 

1 CSA Correspondence - Army Detainee Operations & Detainee-Interrogation Operations -

1 lntegration '- 17 Sep 04 

CSA Correspondence -Appendices to Annex B Army Detainee Operations & Detaineelnterrogation Operations lntegration Plan(Synch Matrix) v2.0 7 Oct 04 

DoD Policy Memorandum on Medical Care for Enemy Persons Under U.S. Control 

Detained in Conjunction with Operation Enduring Freedom - 10 Apr 02 

DoD Policy Memorandum on Procedures for Investigation into Deaths of Detainees in the 

Custody of the Armed Forces of the United States - 9 Jun 04 

DOJ (FOUO) Memorandum on the Legal Standards Applicable under 18 United States 

Code, Statutes 2340-2340A (Standards of Conduct for Interrogation) -30 Dec 04 

GTMO - Behavioral Science Consultation Team Joint Intelligence Group, (bj(2)~2 

(b)i~z SOP - 28 Mar 05 - Redacted Document 

GTMO Memorandum "Operational Policy Memorandum 14 "Behavioral Science 

Consultation Team" -10 Dec 04 

Exhibit E 27-7 
GTMO Detainee Hospital SOP 010 - Medication Dispensing Policy - 18 Jan 04 

GTMO Detainee Hospital SOP 01 1 Out-Processing Procedures - 21 Mar 03 

GTMO Detainee Hospital SOP 014 Detainee Weight Management and Nutrition 

Program - 21 Mar 03 

GTMO Detainee Hospital SOP 015 Mental Health Services to Detainees - 1 Feb 04 

GTMO Detainee Hospital SOP 01 7 Detainee Medical Transports - 9 Mar 04 

GTMO Detainee Hospital SOP 021 Infection Control (Undated) 

GTMO Detainee Hospital SOP 029 Nursing - 3 Oct 03 

GTMO Detainee Hospital SOP 034 Medical department Training (Undated) 

GTMO Detainee Hospital SOP 035 Guidelines for Role of Independent Duty Corpsmen 

- 4 Mar 03 

GTMO Detainee Hospital SOP 036 Guidelines for Role of Physician Assistants - 4 Mar 

8 03- - I GTMO Detainee Hospital SOP 050 Detainee refusal of Care - 7 Aug 03 

1 GTMO Detainee Hospital SOP 060 Cardiac Arrest Procedures at Camp Delta - Apr 04 

1 GTMO Detainee Hosoital SOP 061 Block Nurse (Undated) 

GTMO Detainee ~ospital SOP 068 Emergency Medical ~;eatment SOP - May 04 

Joint lnterrogation & Debriefing Center (JDIC) Briefing " Abu Ghrayb, Iraq" (Undated) 

OSD-DA (FOUO) Detainee Medical Policv Briefinn - Nov 04 

OSD (FOUO) ~emorandum Addressing the emorand or and urn on the US Statute 

Implementing the Convention Against Torture - 27 Jan 05 

SECDEF DEPUTY Policy Statement and Guidelines on Body Cavity Searches and 

Exams for Detainees Under DoD Control - 12 Jan 05 

SECDEF Policy Memorandum on Handling of Reports from the International Committee 

of the Red Cross - 14 Jul04 

MEDCOM SJA lnformation Paper - Health Care Professional Detainee Abuse Reporting 1 Requirements - 8 Sep 04 

1 MNC-I Completed Technical Assist Visit lnspection of CP BlAP (Undated) 

1 MNC-I Completed Technical Assist Visit lnspection of CP Victory - 10 Sep 04 

1 MNC-I Completed Technical Assist Visit lnspection of CP Grey Wolf - 12 Sep 04 

1 MNC-I Completed Technical Assist Visit lnspection of CP Curevo - 17 Sep 04 

1 MNC-I Completed Technical Assist Visit lnspection of CP Renegade - 6 Oct 04 

1 MNC-I Completed Technical Assist Visit lnspection of CP Caldwell - 7 Oct 04 

1 MNC-IJA lnformation Paper "Scope of Medical Care for Security Detaineesn- 29 Sep 04 

1 MNF-I Surgeon's lnformation Brief (Mar-Apr 05 

1 MNF-I (FOUO) Policy XX-YY (Detention Operations) -- 24 Jan 05 

1 MNF-I Policy (Provision of Healthcare to Detainees) - 17 Feb 05 

1 MNF-I SOP (Detainee Healthcare) - 21 Feb 05 

MNF-I SOP i~uberculosis Policy and Procedures) - 25 Feb 05 

1 MNF-I SOP for Ensuring Separation of Detention Operations Functions (Healthcare, 1 lnterrogation Operations, and Custody and Control) - 12 Feb 05 

1 MNF-I & MNC-I (FOUO) Detention Center Technical Assistance Visit Checklist (blank) 

MNF-I surgeon2; 30 ~ab Assessment (Medical) for Feb 05 - 23 Feb 05 

(b)(2)-2 Policy (Care of Iraqi Civilians at l(b)(2)-2 FOB Abu Ghraib) - 25 Oct 04 

b'(2'~2 ~entalHealth Evaluations Policv -1 Seo 04 

Exhibit E 27-8 
'b"2'~2 Mental Health Appraisal Policy -1 Sep 04 

'b"2'b2 [~entalHealth Screening Policy - 15 Jan 05 

'b"2'~2 l~etaineeMental Health Screening Checklist (English &Arabic) 

(b)(2)~2 OIF Theater Detention Healthcare Policy - plus appendices - Jan 05 

Appendix l(Theater Policy Regarding the Physical Examination of Detainees) to OIF 

Theater Detention Healthcare Policy 

Appendix 2 (Patient Right's, Rules, and Responsibilities -English and Arabic) to OIF 

Theater Detainee Healthcare Policy 

Appendix 3 -'b"2'2Detainee Operations "Standard Operating Procedures for Ensuring 

Separation of Detention Operation Functions (Healthcare, lnterrogation Operations, and 

Custody and Control)" - 12 Feb 05 

Appendix 4 (Medical In-Processing of Security Detainees) to OIF Theater Detention 

Healthcare Policy 

Enclosure - DETAINEE HEALTH AND MEDICAL RECORD OF quality assurance screen 

(SF600 overprint , ver 1.I, IAW AR 190-8) to Appendix 4 (Medical In-Processing of 

Security Detainees) to OIF Theater Detention Healthcare Policy 

Enclosure - DETAINEE HEALTH AND MEDICAL RECORD OF SCREENING 

EXAMINATION 

(SF600 overprint, ver 1.4, IAW AR 190-8 to Appendix 4 (Medical In-Processing of 

Security Detainees) to OIF Theater Detention Healthcare Policy 

Appendix [Number not indicated] (Theater Policy Regarding the Dental In-Processing of 

Detainees) to the OIF Theater Detainee Healthcare Policy 

Appendix 5 (Theater Detention Facility TB SOP) to OIF Theater Detention Healthcare 

Policy 

Appendix 6 (Theater Policy for Detainee Patient Identification) to OIF Theater Detention 

Healthcare Policy 

Appendix 7 (Theater Detainee Dispensary Services) to the OIF Theater Detention 

Healthcare Policy 

Appendix 8 (Detainee Medication Administration Procedures) to OIF Theater Detainee 

Healthcare Policy 

Appendix 11 7Standing Operating Procedure - Early Release of Detainee Due to 

Medical Circumstances -aka Compassionate Release SOP) to OIF Theater Detainee 

Healthcare Policy -7 Nov 04 

Appendix [Number not indicated] (Detainee Assault or Abuse Reporting) to OIF Theater 

Detention Healthcare Policy) 

Appendix [Number not indicated] (Detainee Death Standard Operating Procedure) to the 

OIF Theater Detention Healthcare Policy 

Appendix [Number not indicated] (Detainee Outpatient Wound Care) to OIF Theater 

Detention Healthcare Policy 

(b)(2)-2 Mission Essential Task List (Undated) 

(bW2 1 Poster "Tenets of Detention Healthcare" - Mar 05 

b)(2)-2 Soldier Cards "Tenets of Detention Healthcare" -Mar 05 

(b)(2)-2 ~etaineeOperations Standard Operating Procedures for Detainee Healthcare 

1 and Medical Support to lnterrogation Operations - 27 Sep 04 

1 USSOUTHCOM Regulation 1-20 (Human Rights Policy and Procedures) - 8 Apr 02 

1 USSOUTHCOM Confidentiality Policy for Interactions Between Health Care Providers 

Exhibit E 27-9 
and Enemy Persons Under U.S. Control, Detained in Conjunction with Operation 

Enduring Freedom - 6 Aug 02 

USSOUTHCOM Policy on Health Care Delivery to Enemy Persons Under U.S. Control at 

US Naval Base Guantanamo Bay, Cuba - 9 Aug 04 

USSOUTHCOM(~"~'SJA Memorandum on "lnit~al Observations from ICRC 

Concerning Treatment of Detainees" -21 Jan 02 

US SOUTH CON((^)(^' SJA Memorandum on "Concerns Voiced by the International 

Committee for the Red Cross (ICRC) on Behalf of Detainees" -24 Jan 02 

USSOUTHCOM 'b"2'2 SJA Minutes of ICRC Meeting -2 Feb 04 

USSOUTHCOM~~SJA Memorandum for Record of ICRC Meeting Minutes -9 

Oct 03 

TRAINING RELATED 

bW)-2 "~rocessEnemv Prisoners of WarICivilian Internees (EPWslCls) at a I Collection ~oi'nt or Holding ~rea'' Briefing (Undated) 

rb)(2'2 , Office of Staff Judge Advocate "Law of War" Briefing (Undated) 

1 HQ V United States Army FRAGO 7, Annex T (Revised Training Guidance for Forces 1 Deploying IS0 of Operation lraqi Freedom after September 20,2004) -30 Sep 04. 

HQ V United States Army Appendix 1 to Annex T (Revised Training Guidance for Forces 

Deploying IS0 of Operation lraqi Freedom after September 20, 2004) - 30 Sep 04. 

HQ V United States Army Matrix (Individual and Collective training IAW OIF Change 3 

MSG) (Undated) 

(bW-2 "Deployment Stress Management" 

Briefing (Undated) 

Air Force Judge Advocate General School's Training Session on "The Law of Armed 

Conflict" (Undated) 

Army ~edical ~eiartment"Medical Ethics Training" Briefing (Undated) 

AMEDD Center & School, Military Law Branch "Medical Care of EPW's, Detainees, and 

Civilian Internees" Briefing -4 Aug 04 

AMEDD Center & School, Patient Administration Branch "Medical Documents in Combat 

& Contingency Operations" Briefing -14 Oct 04 

AMEDD Center & School Review of Institutional Training In Accordance With AR 190-8 

(Undated Excel Spreadsheet) 

AMEDD Center & School (Dept of Healthcare Operations) Program of lnstruction for 513- 

91 GI 0 Patient Administration Specialist -24 Apr 02 

AMEDD Center & School (Dept of Combat Medic Training) Program of lnstruction for 

300-91W10 Healthcare Specialist - 16 Jul 03 

AMEDD Center & School (Dept of Preventive Health Services) Program of lnstruction for 

302-91x10 Mental Health Specialist - 19 May 04 

AMEDD Center & School (Dept of Health Services Administration) Program of lnstruction 

for 513-91 GI0 Patient Administration Specialist -30 Nov 04 

AMEDD Center & School (Dept of Combat Medic Training) 91 W PROPONENCY Premobilizing Medical Refresher Training Matrix for USAR and NG units -8 Dec 04 

Consultant to the Surgeon General for Medical Ethics' "Medical Ethics in the Combat 

Zone" Briefing - 17 Nov 04 

Lesson Plan - AMEDD BNCOC - Applied Ethics[WVBN039B / Version I]23 Jan 03 

Exhibit E 27-10 
Lesson Plan - AMEDD BNCOClDental BNCOC - Dental Personnel in Alternate Wartime 

Roles [DPBN32QO 1 Version I] - 05 Jan 04 

Lesson Plan - AMEDD BNCOC - Manage Casualties (RTD, EVAC, DOW, POW ) 

[WVBN014B 1 Version 51 - 08 May 02 

Lesson Plan - AMEDD Captains Career & Warrant Officer Advanced (WOAC) - Laws of 

War and Operations Other Than War [FEIAIOOI I Version I] - 16 Sep 04 

Lesson Plan - AMEDD Center & School - Effects of Geneva Conventions on Medical 

Evacuation [CI 91 WO34 1 Version I] - 27 Sep 00 

Lesson Plan - AMEDD Center & School - Enemy Prisoner of War Procedures [JRC40570 

I Version I] - 01 Jun 04 

Lesson Plan - AMEDD Center & School - FIELD TRAINING EXERCISE (EQB) 

[PEOS003A IVersion 1. I] - 10 Sep 03 

Lesson Plan - AMEDD Center & School - Geneva Convention on the Wounded and Sick 

[JRC4A220 1Version I]- 01 Jun 04 

Lesson Plan - AMEDD Center & School - Healthcare Jurisprudence [HLPADTOR I 

Version I] - 09 Apr 01 

Lesson Plan - AMEDD Center & School - Internally Displaced Persons (IDP) 1 Refugee 

Camp Assessments [PESO0030 I Version I] - 16 Dec 02 

Lesson Plan [DRAFT] - AMEDD Center & School (91W10)- International Humanitarian 

Law and the Geneva Conventions -[30 Mar 051 

Lesson Plan - AMEDD Center & School - Law of War [WVBN042B 1 Version I] - 04 May 

01 

Lesson Plan - AMEDD Center & School - Law of War [WVBN042B 1 Version 31 - 09 Nov 

na 

Lesson Plan - AMEDD Center & School - Law of War [HLOBCLOW 1 Version 041 - 03 

Sep 04 

Lesson Plan - AMEDD Center & School - Legal Aspects of Preventive Medicine 

[HLPREVMA 1 Version 03F] - 21 Mar 03 

Lesson Plan - AMEDD Center & School (Medical Evacuation Doctrine & Flight Medics) -

Geneva Convention [UE2C1302 1 Version I] - 18 Aug 03 

Lesson Plan - AMEDD Center & School - Medical Legal Issues in Military Healthcare 

[HLOBCMED 1 Version 1 .I] - 20 Sep 04 

Lesson Plan - AMEDD Center & School - Military Justice [HLOBMJOO IVersion 06981 -

I5 Sep 04 

Lesson Plan - AMEDD NCO Advanced (NCOES) - Enemy Prisoner of War (EPW) 

Casualties [WYANOOGB I Version I] - 17 Apr 03 

Lesson Plan - AMEDD NCO Advanced (NCOES) Law of War [WYAN039B 1 Version 1115 

Dec 04 

Medical Paper (Murray, Roop, & Hospenthal) "Medical Problems of Detainees after the 

Conclusion of Major Ground Combat During Operation Iraqi Freedom" (Undated) 

Power Projection Platform (Ft Bliss) Required Training List for All Individuals Processing 

Through the CONUS Replacement Center (CRC)" -29 Nov 04 

Power Projection Platform (Ft Bragg) Standard Training Package -"Coordinate Internee 

Hospitalization (1 91 -384-4409) (Undated) 

Power Projection Platform (Ft Bragg) Standard Training Package -Yssue Medication to 

Internees" (1 91 -381 -1 338) -Oct 03 

Exhibit E 27-1 1 
Power Projection Platform (Ft Bragg) Standard Training Package -"Supervise 

Administrative and Disciplinary Measures in an lnternment Facility" (191-383-3396) -Oct 

03 

Power Projection Platform (Ft Bragg) Standard Training Package -"Supervise Work 

Activities Within an lnternment Facility" (191-382-2352) - Oct 03 

Power Projection Platform (Ft Bragg) Training Task -"Conduct Security Operations for 

Hospitalized Internees" (19-2-3510) - Jan 05 

Power Projection Platform (Ft Bragg) Training Task -"Supervise Work Project 

Operations for Enemy Prisoners of War (EPWs) and Civilian lnternees (Cls)" (19-2- 

3610)-Jan 05 

Power Projection Platform (Ft Bragg) Training Task -"Supervise Work Project 

Operations for United States (US) Military lnternees (19-2-3204) -Jan 05 

Power Projection Platform (Ft Carson) -'i7th Infantry Division & Ft Carson Detainee 

Training Guidance , 2" Quarter, Fiscal Year (FY) 05" (Undated) 

Power Projection Platform (Ft Hood) "Mandatory Briefings and Force Protection Lane 

Training" - 12 Jan 05 

Power Projection Platform (Ft Lewis) "GTMO 6.0 Detainee Operations Brief' (Undated) 

Power Projection Platform (Ft Riley) "Theater Specific Requirements for Operation lraqi 

Freedom 05-07 -Version 1 CSICSS (With FORSCOM 4 Guidance)" -22 Feb 04 

Power Projection Platform (Ft Stewart) "Medical Training Matrix for Mobilizing RC 

Combat Units" -9 Jan 05 

Training Support Package (TSP) to AR 190-8 for Medical Personnel who Handle, Treat, 

Monitor and or Evacuate Enemy Prisoners of War (EPW), Retained Personnel (RP), 

Civilian lnternees (CI) and Other Detainees (Undated) 

CLASSIFIED 

(S) Treatment of Enemy Combatants Detained at Naval Station Guantanamo Bay, Cuba, 

and Naval Consolidated Brig Charleston (dated 11 May 04) 

(S) ANNEX Q to USARCENT OPLAN 1003-96 (Dated 1 April 1997) 

(S) APPENDIX 7 (MEDICAL) to ANNEX I to V CORPS OPLAN 1003 (Dated 1 December 

1998) 

(S) MNF-I ANNEX Q to MNF-I Framework OIPORD (U) - 22 Mar 05 

(S) MNF-I ANNEX Q (Health Service Support) - 7 Dec 04 

(S) MNF-I SOP (Intra-Theater Military Airlift for Security Detainees -DRAFT) - 1 Mar 05 

(s) MNF-I policy 05-02 (interrogation Policy) - 27 Jan 05) 

MNF-I Surcleon's 30 Dav Assessment (Medical) for Jan 05 (Secret) - 25 Jan 05 

MNF-I surgeon's 30 ~a; Assessment (~edicaljfor Mar 05 (secret) - 23 Mar 05 

(S) MNC-I ANNEX Q (Health Service Support) TO MNC-I Campaign Plan: Operation 

lraqi Freedom - 22 Aug 04 

(S) MNC-I ANNEX Q TO MNC-I FRAMEWORK OPLAN (Medical Services) - 20 Mar 05 

(Draft) \- ~ ~,

(S) FORSCOM FRAGO 20 to FORSCOM Deployment Order IS0 Operation lraqi 

Freedom Rotation 2 (VDEPORD - Recognizes detainee HC shortfall) - 29 May 04 

(S) Detainee Operations Responsibilities -21 Jan 05 

(S) V CORPS FRAGO 006M [Detention of Civilians] to V CORPS OPORD 0303-343 - 19 

Mar 03 

Exhibit E 27-12 
(S) V CORPS FRAGO OlOM [V CORPS EPW Operations] to V CORPS OPORD 0303- 

~ (S) V CORPS FRAGO 018M [Obligations to Children Under Age 18 in US. Custody] to V 

CORPS OPORD 0303-343 343 - 24 Mar 03 -IgMaro3 

(S) V CORPS FRAGO 037M [Change to FRAGO 01 OM: V CORPS EPW Operations] to 

V CORPS OPORD 0303-343 - 20 Mar 03 

(S) V CORPS FRAGO 038M [Establishment of Class Vlll Accounts] to V CORPS 

OPORD 0303-343 - 21 Mar 03 

(S) V CORPS FRAGO 329M [Transition to Stability Operations in Baghdad Secured 

Zones] to V CORPS OPORD 0303-343 - 11 Apr 03 

(S) V CORPS FRAGO 349M [Seizure of Iraqi Prisons] to V CORPS OPORD 0303-343 -

OPORD 03-036 - 1 Jul03) 

(S)

27 Jul03 

OPORD 03-036 - 11 Dec 03 

(S) MNC-I FRAGO 494 (Security for Detainees While in Medical Treatment Facilities) to 

(bW2 1 OPORD 04-01 - 25 Mar 04 1 (S)l(bx2)-2 FRAGO 014 (Task Organization Change)l(bx2)-2 TACON over MP medical 

Personnel - 16 Oct 04 

(S) MNC-I FRAGO 016 (Health and Sanitation Inspections in Support of MNC-I Detention 

Facilities) to MNC-I OPORD 04-01 TO be Published {TBP}) - 17 Apr 04 

(S) MNC-I FRAGO 018 (Medical Record Documentation and Filing System for U.S. 

Detainee Operations in Iraq AO) to MNC-I OPORD 04-01 (TBP) - 17 May 04 

1 (S) MNC-I FRAGO 260 (Investigating and Reporting Detainee Deaths) to MNC-I OPORD 

1 04-01 - 29 Jun 04 

1 (S) MNC-I FRAGO 329 (Detention Operations) to MNC-IOPORD 04-01 - 12 Jul 04 

~&, S MNC-I FRAGO 955p'(2)~2 to Move Medical Equipment Sets to Bucca IS0 

to MNC-I OPORD 04-01 - 3 NOV 04 

(S) MNC-I FRAGO 1029 (Attach 40 Bed Patient Hold Capability to(b)(2'~2 to MNC-I 

OPORD 04-01 -13 NOV 04 

1 (S) MNC-I FRAGO 1043 (Detainee Acceptance) to MNC-I OPORD 04-01 - 15 Nov 04 

1 (S) MNC-I FRAGO 1173 (Detention O~erations) to MNC-I OPORD 04-01 - 2 Nov 04 ' isjrb)(2)-2 FRAGO 330 [Medical Coverage for MND-CS] tqx2)-2 

OPORD Final Thrlst - 1 O'Aug 03 ( 1 FRAGO 341 [Medical Coverage for The Abu Ghraib Prison] tow 

OPORD Final Thrust - 14 Aug 03 (s)(b1(2)~2 FRAGO 468 [Medical Equipment to Abu Ghraib Prison] to OPORD 

Final Thrust - 9 Nov 03 1 (S ~(21~ JOPLAN04-02 (Iraqi Freedom) - IMar 04 

Annex EE [Baghdad Central Detention Facility (BCDF) 

BDE OPLAN 04-02 (Iraqi Freedom) - 1 Mar 04 

Exhibit E 27-13 
q(2)~2
 (FRAGO6 (Detainee Operations Guidance) to Operations Order 02-01 - 4 

mb'(2'-2 Jun 02 

FRAGO 274 (Detainee Handling, Movement, and Temporary Transfer 

Guidance) - 26 Feb 04 

(b~2)-2 Questioning and Interrogation Approaches SOP - 15 Jan 05 jjj-Detainee Operations Standard Operating Procedures - 21 Jan 05 

Standard Operating Procedures for Detainee Medical Care - 8 Mar 05 

(S) CDR USSOUTHCOM EXORD for Detainee Movement Operation 45 - 25 Feb 05 

(s)y~ehavioral Science Consultation Team Standard Operating Procedures -

11 Nov 02 

Exhibit E 27-14