Julie Beck: What role did doctors play in this CIA-mandated torture, and how integral was it?

Steven Miles: What’s new here is the CIA side. The role of doctors in torture during the War on Terror has been pretty well excavated on the Defense Department side, but the CIA [has some exemptions] from Freedom of Information Act requests, so that’s remained hidden. Essentially the doctors and psychologists were built in to the entire torture system. They weren’t simply bystanders who were called in to respond when the system went off the rails. Some doctors apparently protested this. But they kept their protests inside [the CIA], they never went outside, which they should have done when they saw these types of abuses.

In general, doctors in torture have a couple roles. Number one, they design methods of torture that do not leave scars. For example, the so-called “rectal feeding” which is actually a medieval technique in which the intestines are inflated with a viscous material to cause intestinal pain. The docs are also involved in making sure that the prisoners who weren’t supposed to die didn’t die. The third thing doctors do is they falsify medical records and death certificates to conceal the injuries of torture. [Ed.: Miles has written on this in the context of Abu Ghraib.]

Beck: When we’re talking about how integral it was, is the medical knowledge that doctors bring to these operations something interrogation programs could not do without? If every doctor in the world refused to participate, would they be out of luck?

Miles: There are two answers to this question. One is, doctors get the prisoners that the Red Cross never sees. So in a sense doctors are frontline human-rights monitors who get into places where regular human rights groups can’t go. Number two, there are a set of professional codes, that are endorsed by the American Medical Association and the World Medical Association, that describe doctor’s duties not only to avoid participating in torture, directly or indirectly, but also a duty to document it and to report it, going outside the chain of command if necessary.

As human rights groups have put additional pressure on regimes around the world with regard to torture, regimes that are responsive to human rights pressure want to use torture that doesn’t leave scars. So they prefer methods like asphyxiation, isolation, cramming people in small boxes, white rooms with loud noises, because it just destroys people psychologically. Whereas regimes like Assad’s regime [in Syria] don’t really care if there are scars. So there is no role for medicine in that respect in an Assad-type regime or in North Korea’s regime.

Beck: So really the doctors become more important in places like the U.S. where if things like this got out, people would pressure the government?