That the torture was overseen by medical professionals is a violation of international laws and treaties and, additionally, a breach of numerous professional ethical codes, including the United Nations Principles of Medical Ethics and the Declaration of Tokyo.
The background paper said the use of torture at the CIA's "black site" prisons "is essential to the creation of an interrogation environment conducive to intelligence collection."
High-value detainees "are well-trained, often battle-hardened terrorist operatives, and highly committed to jihad. They are intelligent and resourceful leaders and able to resist standard interrogation approaches."
"However, there is no template or script that states with certainty when and how these techniques will be used in combination during interrogation," the background paper stated. "The interrogators' objective is to transition the HVD [High-Value Detainee] to a point where he is participating in a predictable, reliable, and sustainable manner. Interrogation techniques may still be applied as required, but become less frequent.
"This transition period lasts from several days to several weeks based on the HVDs response and actions. The entire interrogation process outlined above, including transition may last for thirty days."
The December 30, 2004, document was prepared by the CIA for Dan Levin in the Justice Department's Office of Legal Counsel. The background paper included an unsigned note on the fax cover sheet that said, "Dan, A generic description of the process. Thank you."
"The background paper is a profoundly disturbing document that illustrates, as well as anything could, how far the CIA strayed from the law and from values that are integral to our democracy," said Jameel Jaffer, director of the ACLU National Security Project. "That the barbaric methods outlined in the paper were approved by the country's senior-most officials is particularly appalling."
The background paper reads as an instructional manual for interrogators on how and when to implement the "combined use of interrogation techniques" after a terror suspect is captured and "renditioned" to a "black site" prison in another country.
"The purpose of interrogation is to persuade High-Value Detainees (HVD) to provide threat information and terrorist intelligence in a timely manner, to allow the US Government to identify and disrupt terrorist plots and to collect critical intelligence on al-Qa'ida," the background paper said. "In support of information previously sent to the Department of Justice, this paper provides additional background on how interrogation techniques are used, in combination and separately, to achieve interrogation objectives ..."
The background paper then describes what happens after a terror suspect is captured and turned over to the CIA. The background paper described this as "rendition."
"The HVD is flown to a Black Site ... A medical examination is conducted prior to the flight," according to the background paper. "During the flight, the detainee is securely shackled and is deprived of sight and sound through the use of blindfolds, earmuffs, and hoods. There is no interaction with the HVD during this rendition movement except for periodic, discreet assessments by the on-board medical officer. Upon arrival at the destination airfield, the HVD is moved to the Black Site under the same conditions and using appropriate security procedures."
The so-called "Reception at Black Site" that follows involves a medical assessment and "administrative procedures." Detainees' head and faces are then shaved and they are photographed while nude to "document the physical conduction of the HVD."
"The medical officer also determines if there any contraindications to the use of interrogation techniques." Contraindications is defined as a pre-existing condition or other factors that would increase the risk of either using a specific drug, carrying out a medical procedure or engaging in a particular activity.
Detainees are then interviewed by psychologists, who prepare reports about detainees' mental states and if there are any "contraindications to the use of interrogation techniques."
At this point, interrogators begin to question a detainee - "in a relatively benign environment" - to gain an understanding of the prisoner's "resistance posture" and if he would be willing to cooperate in providing CIA interrogators with immediate information about terrorist plots against the United States.
"The standard on participation is set very high during the Initial Interview," the background report said. "The HVD would have to willingly provide information on actionable threats and location information on High-Value Targets at large - not lower level information - for interrogators to continue with the neutral approach."
The interrogation process, according to the background paper, is broken down into three categories: conditioning techniques, corrective techniques and coercive techniques.
The background report describes the detention conditions detainees are subjected to and states that, while that is not considered an interrogation technique, the conditions of their confinement will have an impact when they are interrogated.
The next phase is referred to as "conditioning techniques," where a detainee is reduced to a "baseline, dependent state" as a result of a combination of tactics that leaves the detainee feeling he has no control over basic human needs. The "baseline state" is crucial, according to the background report, because it is supposed to make the detainee feel that his welfare is more important than the "information he is protecting."
The combination of interrogation techniques, approved in Justice Department legal memoranda, to reduce a detainee to a dependent state includes nudity, sleep deprivation and dietary manipulation.
The paper noted that merely introducing these techniques alone won't bring immediate results. Rather, it's the repeated use of these techniques and using their combined use "which achieves interrogation objectives."
Clinical descriptions of how to effectively administer these methods is then described. The background paper said that high-value detainees remain nude for an indefinite period of time. Detainees then are deprived of sleep and are placed in the "vertical shackling position to begin sleep deprivation."
"Other shackling procedures may be used during interrogations," the report said. "The detainee is diapered for sanitary purposes, although the diaper is not used at all times."
Dietary manipulation then follows, whereby a detainee is fed Ensure Plus "or other food at regular intervals." Detainees receive a "target" of 1,500 calories a day based on guidelines from the CIA's Office of Medical Services.
A high-value detainee who, presumably, is uncooperative, then goes through the "corrective techniques" phase, which involves the "insult slap," "abdominal slap," "facial hold" and "attention grasp." The report said these methods are not administered simultaneously during an interrogation, rather they are interchangeable.
The insult slap "is often the first physical technique used with an HVD once an interrogation begins."
"As noted, the HVD may already be nude, in sleep deprivation and subject to dietary manipulation, even though the detainee will likely feel little effect from these techniques early in the interrogation," the report said. "The insult slap is used sparingly but periodically throughout the interrogation process when the interrogator needs to immediately correct the detainee or provide a consequence to a detainee's response or non-response.
"The interrogator will continually assess the effectiveness of the insult slap and continue to employ it so long as it has the desired effect on the detainee. Because of the physical dynamics of the various techniques, the insult slap can be used in combination with water dousing or kneeling stress positions. Other combinations are possible but may not be practical."
The same methods are employed when an interrogator uses the abdominal slap, the attention grasp and the facial hold. The next phase involves what the report called "coercive techniques," some of which were first disclosed in Justice Department legal opinions released in April. Those methods include, walling, water dousing, stress positions.
Cramped confinement, according to the report and the CIA's Office of Medical Services, calls for placing a detainee in a large box, no more than eight hours at a time, for "no more than 18 hours a day." The report also said interrogators can use a small box, no more than two hours at a time, and no more than 18 hours per day.
Because of the "unique" aspects of "cramped confinement," it cannot be combined with other torture methods.
The process that follows next is a sort of checklist for interrogators or, as the report said, "a day-to-day look" at the interrogation process.
Here's what the report said:
A hooded high-value detainee is taken to the interrogation room and, under the direction of interrogators, is stripped, placed into shackles and positioned with his back to the "walling wall." Interrogators approach the detainee, place the walling collar over his head and around his neck and stand in front of him.
The detainee's hood is then removed and the interrogator explains to the prisoner that he will do "whatever it takes to get important information" from him. If the detainee begins to resist he is immediately slapped across his cheek. If that doesn't work, the prisoner is then slapped on his stomach.
Once it became clear to interrogators that a detainee was "lying, withholding information, or using other resistance techniques," the interrogator would repeatedly slam the prisoner head first into a wall. Then the detainee would be placed in the center of the interrogation room - nude - diapered, and shackled and deprived of sleep. White noise not exceeding 79 decibels would then be played to as a tool to keep the detainee awake.
"This first interrogation session may last from 30 minutes to several hours based on the interrogators' assessment of the HVD's resistance posture," the background paper said.
Another torture session follows and the time lapse could be as short as one hour or as long as a day. Between the first and second sessions, medical and psychological personnel observing the torture must advise "there are no contraindications to another interrogation session."
The second round of torture follows the exact same pattern as the first; the detainee is placed in front of the "walling wall" and asked a series of questions and, depending on the answers, is slammed into the wall, slapped on his face and stomach. Except during this session, a detainee who fails to respond in a satisfactory manner is doused with water for several minutes. Stress positions and wall standing are also integrated.
Sleep deprivation and dietary manipulation and white noise are repeated again if a detainee does not provide information his interrogators believe he has. The detainee is nude at all times.
And then the process is repeated for a third time, with the methods and line of questioning becoming more intense. For example, slamming a detainee into a wall would be repeated multiple times. Or, if a detainee placed in a stress position fails to remain in that position, he would be slammed into the wall. The only way for a detainee to stop this brutal treatment, the background paper noted, is by "cooperating with interrogators."
Interrogators can then decide, after the third round of torture ends, to put a detainee in either a large or small box if it will have "the appropriate effect."
Sleep deprivation can then continue for five days straight "or possibly beyond for the hardest resisters," but it cannot exceed 180 consecutive hours.
"Sleep deprivation will end sooner if the medical or psychologist observer finds it necessary," the background paper noted. "On average, the actual use of interrogation techniques can vary upwards to fifteen days based on the resilience of the HVD."
If interrogators need to exceed a 30-day preapproved period, the interrogation team would need to submit a new interrogation plan to CIA headquarters in Langley.
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