Wednesday, July 06, 2005

What Geneva Convention?

A Special Article in the online publication Medscape General Medicine, Medical Investigations of Homicides of Prisoners of War in Iraq and Afghanistan by Steven H. Miles, MD, posted yesterday (7/5/05), is dismaying and angering, full of details which should be read but which I don't have room (or the heart) to copy here. Read it in its entirety if you have the stomach.

Here are some excerpts:
The publication of the photographs of the abuse of prisoners at Abu Ghraib has resulted in a widening circle of disclosures and official investigations of similar abuses in Iraq, Afghanistan, and at Guantanamo Bay. There are reports that some medical personnel neglected detainees' medical needs and collaborated with coercive interrogations.[1,2] Some physicians, medics, nurses, and physician assistants failed to report abuses or injuries caused by the abuses that they witnessed. This article reviews another human rights issue -- the medical evaluation of cases of which prisoners potentially died of because of mistreatment or under suspicious circumstances.
The article then quotes from the relevant sections of the Geneva Convention. Here is only some of what the Convention requires of medical personnel:
Excerpts From the "Geneva Convention Relative to the Protection of Civilian Persons in Time of War" (1949)

Article 129: Deaths of internees shall be certified in every case by a doctor, and a death certificate shall be made out, showing the causes of death and the conditions under which it occurred. An official record of the death, duly registered, shall be drawn up in accordance with the procedure relating thereto in force in the territory where the place of internment is situated, and a duly certified copy of such record shall be transmitted without delay to the Protecting Power as well as to the Central Agency referred to in Article 140.

Article 130: The detaining authorities shall ensure that internees who die while interned are honourably buried, if possible according to the rites of the religion to which they belonged, and that their graves are respected, properly maintained, and marked in such a way that they can always be recognized. . . . As soon as circumstances permit . . . the Detaining Power shall forward lists of graves of deceased internees to the Powers on whom the deceased internees depended, through the Information Bureaux provided for in Article 136. Such lists shall include all particulars necessary for the identification of the deceased internees, as well as the exact location of their graves.

In the wake of the Abu Ghraib revelations in 2004, the Department of Defense called a hurried press conference to discuss reports of detainee deaths. At that time death certificates were produced:
The May 2004 death certificates appear to have been finalized for the press conference rather than completed during the routine work of the pathologists. Most bear preliminary signatures dated within a week of the death, but 17 of 22 certificates for deaths occurring between 2002 and 2004 were finalized within 9 days of the press conference. It appears that pathologists signed his or her batch of certificates at a single sitting at which the earlier and later signatures were affixed. Figure 2, for example, shows all 5 death certificates signed by Major Michael E. Smith. It appears that he used 1 pen and signature mark to simultaneously put a preliminary signature on certificates dated August 22, 23, and 25, 2003 and on October 23 and December 2, 2003, and then finalized those same certificates on May 12, 2004 with the same pen and hand stroke. A similar pattern is seen on death certificates signed by Colonel Eric Berg, Lieutenant Colonel Elizabeth Rouse, and Major Louis Finelli. James Caruso used the same signatures on his 3 death certificates and signed one for Jerry Hodge on May 13, 2004.
Vital forensic evidence that could have resulted in criminal proceedings against military personnel who murdered prisoners was mishandled by the Armed Forces Institute of Pathology's Office of Medical Examiners that made prosecution difficult or impossible:
The Office of Medical Examiners did not develop adequate procedures for preserving evidence for trial. The cooler containing the autopsy specimens of the murdered prisoner, Mr. Nagen Sadoon Hatab, exploded while sitting on a hot airport tarmac awaiting transport to trial. Pathologist Colonel Kathleen Ingwersen lost the broken neck hyoid (wishbone) bone showing that a soldier had strangled Mr. Hatab. The throat and rib cage were found on 2 different continents. As Dr. Ingwersen explained, "I should have paid closer attention . . . instead of relying on what turned out to be a miscommunication with my assistant." She suggested that she mishandled evidence because she was taking a drug to treat an allergic reaction to sandfly bites. The Armed Forces Institute of Pathology then obstructed the trial by refusing to allow independent DNA testing on the decedent's rib cage that they had temporarily lost so that the prosecution could prove that it came from the decedent.
These are almost random excerpts. There is much more in this discouraging and disheartening article. What has our profession come to?