We are doing grave damage to our soldiers in Iraq. This
piece in the NYT is horrifying as to what is happening to the medical personnel
and the detainees in Iraq. The Pentagon and this Administration are responsible for what is happening and we need to find a way to make them answerable for this situation. I cried as I read this piece. This is just more of this Administration’s lack of care for the rule of law and moral behavior. I am posting the whole piece here as I think it is too important to be left to the NYT archive system. This is horrifying.
Read this and weep.
February 4, 2005
OP-ED CONTRIBUTOR
Triage at Abu Ghraib
By M. GREGG BLOCHE and JONATHAN H. MARKS
Washington
YOU probably remember the photograph. A tiny female M.P. in baggy fatigues stands over a nude Iraqi man, holding him on a leash. He lies limp, on his side, utterly humiliated, an icon of wartime excess.
The conduct depicted in that photo is difficult to justify under any circumstances. But as it turns out, a few weeks before the photo was taken, use of a leash was approved on medical grounds, according to the Army doctor who commanded the medical unit that cared for Abu Ghraib's prisoners and the American soldiers who guarded them.
During an inquiry we conducted for The New England Journal of Medicine, the doctor, Maj. David Auch, told us that some of the prisoners at Abu Ghraib were psychotic and out of control. One, he said, would repeatedly strip off his clothes and smash his head against the wall. After handcuffs and a helmet failed to stop him and with straitjackets unavailable, some soldiers suggested the leash. Major Auch granted their request. "My concern was whatever it took to keep him from getting hurt," he said.
It is easy to criticize Major Auch for allowing M.P.'s to use a leash, but it is difficult to say what he should have done instead. He had antipsychotic drugs on hand but no psychiatrists to prescribe them, and he lacked the experience to give these powerful drugs himself.
So the leashed detainee went untreated, as did hundreds of others with mental disorders. The lone psychologist who accompanied Major Auch, First Lt. Joseph Wehrman, was troubled by what he found on their weekly visits. Up to 5 percent of the detainee population (which averaged 2,000 in late 2003 and early 2004) was mentally ill, Lieutenant Wehrman told us, but to his knowledge, none of the prisoners received medication.
The atmosphere at Abu Ghraib hardly promoted sanity. Mortar shells landed almost daily, according to military personnel we interviewed, and prisoners often rioted, sometimes using smuggled weapons, with deadly effect. In late 2003, Major Auch's unit set up a field hospital, bringing a full-time medical presence to the prison for the first time. For the dozen or so clinicians assigned to the hospital, the daily routine was surreal.
At times the hospital lacked basic supplies, according to members of the clinical staff, and at times it maintained a surgical service without surgeons. Sometimes the hospital ran out of chest tubes, intravenous fluids or medicines. Medical staff members improvised, taking tubes from patients when they died and reusing them, without sterilization.
Physician's assistants and general practitioners amputated limbs, a dentist did heart surgery, and Major Auch begged and bartered with other medical units for drugs and intravenous fluids. When they ran out of blood sugar test strips for Abu Ghraib's many diabetics, according to a medic assigned to the unit, they gave insulin by guessing the dose and watching for bad reactions.
Amid murderous shortages, there were paradoxes of plenty. Major Auch's men received sophisticated equipment like digital X-ray machines, several said, but they weren't taught how to use it. And in fact, a psychiatrist was assigned to Abu Ghraib for a few months. But he treated no patients; that wasn't his job. He was supposed to help military intelligence make interrogation plans.
Through their nerve and initiative under fire, Abu Ghraib's clinicians saved lives. To try to do so, they broke rules: dentists aren't supposed to operate on hearts, and physician's assistants don't take off arms or legs.
Nor do doctors manage mental patients by putting them on leashes. We don't condone this practice, and there can be no excuse for the torture and other abuse that many detainees endured at Abu Ghraib. But we are not inclined to blame Major Auch. The men and women who risked their lives to care for Iraqis and Americans alike were put in impossible circumstances by indifference or worse from above.
Pentagon spokesmen say the Army did its best, under trying circumstances, to provide medical care to both troops and detainees. On the battlefield, military medicine performed superbly, keeping ratios of killed to wounded G.I.'s to historic lows. But at Abu Ghraib, the Army all but abdicated its responsibility to provide care to the thousands of people it kept in custody. This neglect bred dire conditions and desperate measures.
The catastrophic failings of medical care at Abu Ghraib put American lives at risk and violated the United States' obligations to care decently for detainees. The soldiers who snapped and posed for the photos of abuse are being called to account. But the focus on their culpability diverts attention from the causal relationship between the Pentagon's priorities and the hellish conditions that both prisoners and their captors endured. This larger story, of conditions that ensured neglect and invited cruelty, is being ignored.
M. Gregg Bloche teaches law and health policy at Georgetown and Johns Hopkins universities, where Jonathan H. Marks is a visiting fellow in bioethics.
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