Abd al Hadi al Iraqi's defense team, from left to right, Navy Lt. Charles D. Ball III, civilian Susan Hensler and Navy Lt. Dahoud Askar. Photo by Patty Nieberg/Medill News Service

The detention facility must plan for at least 25 more years of care, according to a July 2018 memorandum to Joint Task Force Guantanamo from then-Deputy Secretary of Defense Pat Shanahan. Photo by Patty Nieberg/Medill News Service

GUANTANAMO BAY NAVAL BASE, Cuba, Jan. 16 (UPI) -- The case of a medically impaired detainee has raised larger questions about whether the detention facility at Guantanamo Bay, Cuba, is equipped to handle an aging and increasingly fragile population.

Abd al Hadi al Iraqi was brought to the prison in 2007 with a pre-existing degenerative disc disease and has undergone five spinal surgeries over the past two years. Hadi, 57, has been charged with war crimes as an alleged commander of al-Qaida fighters in Afghanistan after 9/11. The military commission held pretrial proceedings this month to determine accommodations for Hadi's ailing health that would maximize his participation in a trial.


"In medical language, it's a teaching case," said retired Brig. Gen. Stephen Xenakis, who has testified on behalf of the defense teams of several detainees. "Here you've got a man who's got a problem and no matter what we have certain standards that we're supposed to adhere to."

The detention facility must plan for at least 25 more years of care, according to a July 2018 memorandum to Joint Task Force Guantanamo from then-Deputy Secretary of Defense Pat Shanahan.

The task force's 2019 healthcare budget is about $4 million for 1,800 service members and 40 detainees.

The average age of the detainees is 46.

Seven men are being tried in the military commissions, two have been convicted, five are being held and recommended for transfer and 26 are held in indefinite detention without possibility of a transfer, according to the New York Times' continuously updated Guantánamo Docket.


"Once these men get into the 50s, 60s and 70s, they're going to be developing cancer, heart disease, all sorts of other medical problems like diabetes," Xenakis said. "You need diagnostic equipment, you need MRIs, CT scans and you need to be able to do heart catheterizations, procedures, surgery."

Seventy-one-year-old Saifullah Paracha has diabetes and numerous cardiovascular problems, according to a task force assessment. Paracha, who has been held at Guantanamo without charge since 2004, is accused of arranging financial transactions for alleged 9/11 mastermind Khalid Sheikh Mohammed.

Another detainee, 45-year-old Sufyian Barhoumi, has a left metacarpal amputation and suffers from malnutrition and dehydration from hunger striking, according to the task force assessment. Barhoumi, who arrived at the detention facility in 2002, is accused of aiding al-Qaida.

Hadi's lagging recovery has made it difficult to determine whether he's healthy enough to sit for trial. Though a trial date was proposed by the prosecution for summer 2017, it has been continuously postponed due to Hadi's surgeries and his decision to, on multiple occasions, fire attorneys without explanation.

B. Vaughn Spencer, an attorney for the prosecution, said Hadi's competency to stand trial had been established and the hearings should proceed.

Defense attorney Naval Lt. Dahoud Askar told the judge, Marine Lt. Col. Michael D. Libretto, that Hadi's transportation back and forth to meet with his defense team is unfair and sets back his recovery.

The prosecution cited testimony by a senior medical officer, who's name was kept classified to protect his identity, that Hadi's transit to and from the attorney-client meeting space would not endanger his health.


According to the senior medical officer, Hadi takes Percocet and Valium daily to mitigate his pain. Hadi is not officially prescribed any medication, and takes the drugs as needed. During November hearing, he was given Valium and soon after fell asleep in court.

"He's got to choose between pain and medication that he knows the more he takes the more dangerous it will become, and meeting with his attorneys and participating in his defense," Askar said.

During a cross examination of Joint Detention Group commander Army Col. Steven J. Yamashita, civilian defense counsel Susan Hensler asked if he knew the Department of Defense had requested $69 million to improve facility conditions. She then asked Yamashita if he knew that Hadi's cell lights hadn't worked between Jan.1 and 11. He said no.

Hadi is one of 40 detainees at the facility who suffers from complicated medical needs. One of the so-called high-value detainees, Abd al Rahim al Nashiri, 54, suffers from head injuries, which his defense team says he sustained from waterboarding before his arrival at Guantánamo. Nashiri is a Saudi Arabian who has been charged with war crimes, including the 2000 bombing of the USS Cole.

According to his civilian lawyer, Nancy Hollander, Nashiri's case raises larger questions about medical ethics. A declassified 2004 report from the CIA's Office of Inspector General documented Nashiri's torture at a CIA black site. A battle for a civilian court hearing, as opposed to the military commissions, has prevented the evidence from being admissible.

"It's a much bigger deal because he was in the black sites for years and has been diagnosed by the military as having severe PTSD," she said.


Nashiri's defense was able to secure an MRI machine, which Hollander said took two years to get and broke before Nashiri could use it.

"Going into an MRI machine could be really traumatic. It's traumatic for people who haven't been through any of that," Hollander said. "But he definitely needs it because he may well have organic brain damage as a result of what they did to him."

Hadi's defense team told the court that he received an MRI on the second day of hearings after years of requesting one.

Mansoor Adayfi, 40, is a former detainee who was never charged and resettled to Serbia in 2016 after the U.S. government deemed he was not a threat. Adayfi told Medill in a phone interview that detainees were kept in the dark about their medical issues and given treatments based on their participation in interrogations.

"Everything was controlled by [the] psychologist and interrogator," Adayfi said. "If you provide them with some information and you can get whatever they give you. Some detainees from Central Europe, they were treated good. The detainees from Saudi Arabia, some of them [were] treated good, but the rest of us were screwed because simply - call your interrogator, ask your interrogator, your interrogator can help you."

On Monday, Hadi's final hearing for the week was cut short when he experienced back spasms, which limited his breathing.

The next session of pretrial hearings is set for early March.

For future hearings, the defense requested access to Hadi's cell for privileged attorney-client meetings.


The defense is also requesting accountability for the accommodations requested by Hadi and the hiring of a promised pain management specialist.

The Defense Department plans to send a disabled-accessible cell to put Hadi closer to the courtroom and to accommodate his medical needs and eliminate travel time, The Miami Herald reported.

Askar added that the court's "judicial efficiency" would be impaired by denying the defense attorney-client meetings that did not require Hadi to be transported from his location. But again, the prosecution denied that Hadi's transit would worsen his condition.

The prosecution declined to provide further comment on the week's hearings.

"Our main focus is the safe, humane and legal detention of Law of Armed Conflict detainees, which includes quality medical care," said Cmdr. Adam Bashaw, public affairs officer for the task force.

In the case of Hadi and other detainees, the medical oversight is a test of the U.S. government and the military commissions' values, Xenakis said.

"We've got principles that we stand up to and they're trusted in situations like this," he said. "It's not only what you say, it's what you do and that's where I think this case is representative of something."