FIG1 Last October I received an
invitation from William Winkenwerder Jr., M.D., assistant secretar y of
defense for health affairs, to visit the U.S. military base at Guantanamo Bay,
Cuba (GTMO), together with a group of senior military officers and
representatives from the civilian health/mental health care system.
The purpose of the trip was to visit the detainee health facilities and
review policies and practices pertinent to detainee care and management.
Needless to say, I quickly accepted the invitation and soon was oriented,
briefed, and assisted by Col. Robert Ireland, a psychiatrist and program
director for mental health policy in the Office of the Assistant Secretary of
Defense for Health Affairs.
On November 13, 2006, after a night's stay at Andrews Air Force Base, I
boarded a 7 a.m. military plane. The visiting team consisted of about 20
persons, half of them senior officers from the Navy, Air Force, and Army. The
others in the group were psychologists, psychiatrists, and physicians from
specialties other than psychiatry. Among these health care leaders were Dr.
Gerald Koocher, president of the American Psychological Association; Rebecca
Patton, M.S.N., R.N., president of the American Nurses Association; Dr.
Stephen Behnke, an attorney and psychologist who is in charge of ethics issues
at the American Psychological Association; Dr. Eric Zillmer, the Carl R.
Pacifico Professor of Neuropsychology at Drexel University; and Dr. Robert
Frank, dean of the College of Public Health and Health Professions at the
University of Florida.
After a three-hour flight, we landed at GTMO. While landing, I reflected on
my being a U.S. psychiatrist born in Cuba and about to visit and review a
military base located in Cuba. Upon landing, a bus took us to a nearby boat,
and after a boat ride of about 20 minutes, we arrived at the other side of the
military base. Another brief bus ride took us to the GTMO area where about 435
detainees from Iraq, Afghanistan, and other Middle Eastern countries were
detained. On our way to Camp Delta, we toured the housing, schools, and sport
facilities used by military personnel and their families.
During the orientation, briefing, and discussion period, we had an
opportunity to become more familiar with the GTMO military base. For instance,
the briefers told us that all detainees had been arrested while committing
terrorist acts against the United States and that the detainees were accused
of being terrorist trainers, bomb makers, Osama Bin Laden bodyguards, would-be
suicide bombers, and terrorist financiers. Military briefers told us that two
of the terrorism financiers contributed nearly $200 million to the preparation
and execution of the 9/11 terrorist attacks. Military officials also said that
some of the detainees who were released from Camp Delta have returned to their
I am not a lawyer, thus my focus was on whether the detainees were
receiving appropriate health/mental health care as well as humane care. A few
comments in this regard are appropriate. On the day of our visit, we had a
lunch that consisted of pasta and chicken, a salad, an orange, two toasted
bread portions, two glasses of grapefruit juice, a diet soda, a bottle of
water, and two pieces of baklava. As we were having our lunch, we were told
that this was the lunch that all detainees at GTMO had that day.
The detention facilities consisted of two main models, one with high
emphasis on security and the other with a more relaxied atmosphere and more
space for recreational activities. We were told that detainees can advance
from one to the other depending on their conduct and behavior. All cells have
hygienic facilities and common areas for baths and recreation. The
less-restrictive facilities are where most of the disruptive behaviors were
reported to have occurred, including suicides; fights; throwing urine, feces,
and semen in the face of the military personnel; and crafting weapons from all
possible materials. Opportunities for praying were available, as were
translators in all Arabic languages and dialects.
We also had the opportunity to visit the hospital unit in which detainees
needing medical care are treated. The hospital has 19 to 28 beds and is
supplemented by outpatient clinics and a psychiatric/behavioral unit.
Additionally, we were told that the detainees have access to the main naval
base hospital when specialist care is needed.
I must acknowledge that a visit of a few hours does not permit me to judge
the validity of the various press accounts of day-to-day life for the
detainees during their time at GTMO. However, during my return flight that
evening, I thought a lot about the complexity of the situation at GTMO and how
to best recognize and pay respect to the military men and women assigned to
GTMO. In my opinion, the health care personnel—psychiatrists, other
physicians, nurses, psychologists, and others—stationed at GTMO are
doing an outstanding job under difficult and trying circumstances for everyone
at GTMO. This column was written with this message in mind. ▪