If you thought the U.S.’s involvement in the torture of prisoners detained in the “war on terror” was limited only to U.S. military personnel, intelligence officers, wrongheaded prison guards, or, through “extraordinary rendition,” handled by foreign proxies, think again. A new report from The Task Force on Preserving Medical Professionalism in National Security Detention Centers has found that since 9/11, “Military and intelligence-agency physicians and other health professionals, particularly psychologists, became involved in the design and administration of that harsh treatment and torture — in clear conflict with established international and national professional principles and laws.”

According to the recently issued Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror, medical practitioners were involved in such activities as “designing, … and enabling torture and cruel, inhumane and degrading treatment” of detainees. And while the DoD has claimed that it has taken steps to remediate the problems, “including instituting a committee to review medical ethics concerns at Guantanamo Bay Prison,” the report’s authors say that these efforts fall far short of being meaningful.

The report pointed out that in 2010, the institute on Medicine as a Profession (IMAP) and the Open Society Foundations convened the Task Force on Preserving Medical Professionalism in National Security Detention Centers “to examine what is known about the involvement of health professionals in infliction of torture or cruel, inhuman, or degrading treatment of detainees in U.S. custody and how such deviation from professional standards and ethically proper conduct occurred, including actions that were taken by the U.S. Department of Defense (DoD) and the CIA to direct this conduct.”

“The American public has a right to know that the covenant with its physicians to follow professional ethical expectations is firm regardless of where they serve,” said Task Force member Dr. Gerald Thomson, Professor of Medicine Emeritus at Columbia University. “It’s clear that in the name of national security the military trumped that covenant, and physicians were transformed into agents of the military and performed acts that were contrary to medical ethics and practice. We have a responsibility to make sure this never happens again.”

A broad array of “health professionals” and/or “medical personnel,” including physicians, psychologists, registered nurses, nurse practitioners, physician assistants, corpsmen (U.S. Navy or Marine-trained enlisted medical personnel), medics (U.S. Army-enlisted medical personnel), and technicians, participated in, or enabled, torture of detainees.

The Task Force found that post-9/11, U.S. government actions included “three key elements affecting the role of health professionals in detention centers”:

1.“The declaration that as part of a ‘war on terror,’ individuals captured and detained in Afghanistan, Pakistan, and elsewhere were ‘unlawful combatants’ who did not qualify as prisoners of war under the Geneva Conventions. Additionally, the U.S. Department of Justice approved of interrogation methods recognized domestically and internationally as constituting torture or cruel, inhuman, or degrading treatment.”

2. “The DoD and CIA’s development of internal mechanisms to direct the participation of military and intelligence-agency physicians and psychologists in abusive interrogation and breaking of hunger strikes. Although … the military and the CIA, … facilitated that involvement in similar ways, including undermining health professionals’ allegiances to established principles of professional ethics and conduct through reinterpretation of those principles.”

3. In 2004-2005, “leaked documents began to reveal those policies” that had previously been secret. “Secrecy allowed the unlawful and unethical interrogation and mistreatment of detainees to proceed unfettered by established ethical principles and standards of conduct as well as societal, professional, and nongovernmental commentary and legal review.”

To set the U.S. government’s torture policy into motion, it disregarded previous established interrogation guidelines, and violated the Geneva Conventions and the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment and Punishment, treaties that the U.S. was “bound to follow.”

According to Ethics Abandoned, “officials at the highest levels of the government rejected these guidelines, however, stating that they believed traditional methods of interrogation were too time-consuming to prevent feared imminent attacks. As a result, almost immediately after 9/11, the U.S. government adopted abusive methods of interrogation.”

Torture of prisoners began in earnest in late 2001, when those detained “at detention facilities at Bagram Air Base and in Kandahar, [were subject] to beatings, exposure to extreme cold, physical suspensions by chains, slamming into walls, sleep deprivation, constant light, and forced nakedness and others forms of humiliating and degrading treatment.”

What started as trial by torture – a little of this and a little of that – soon developed into “a theory of interrogation … that was based on inducing fear, anxiety, depression, cognitive dislocation, and personality disintegration in detainees to break their resistance against yielding information.”

While torture methods were being experimented with and developed, Bush Administration officials began laying “the legal groundwork for a policy that would abandon restrictions on torture and cruel, inhuman, or degrading treatment imposed by treaty obligations and U.S. criminal law.” By early 2002, in a monumental decision, ”the White House counsel declared that the Geneva Conventions did not apply to detainees at GuantÃ¡namo.”

A secret memorandum from the Justice Department’s Office of Legal Counsel, issued in response to a CIA request, “claimed that an initial core set of 10 ‘enhanced’ methods could be used legally as part of the interrogation program designed for Abu Zubaydah, a designated high-value detainee. The memorandum restricted the definition of severe mental or physical pain or suffering in a manner that permitted draconian interrogation methods, including attention-grasping (grasping a detainee with both hands and drawing him toward the interrogator), throwing a detainee repeatedly against a wall, facial holds (forcibly holding the head immobile), facial slaps, cramped confinement, wall-standing (forcing a detainee to support his weight on his fingers against a wall), stress positions, sleep deprivation, use of insects, and waterboarding.”

The limited role for health professionals during CIA-run torture sessions grew. By 2005, the initial set of 10 “enhanced” methods grew to 14. Time for sleep deprivation increased from no more than 48 hours to 180 hours: “Detainees were kept awake by being shackled in a standing position, hands to the ceiling and feet to the floor, fed by detention personnel and diapered so that nothing interfered with the standing position.”

The detainees were nude; cold water-dousing of nude prisoners, not included in the 2002 memo, was now allowed; and waterboarding “described only briefly in 2002, [as aiming] … to induce the feeling and threat of imminent death,” was described in 2005 “as causing the sensation of drowning and carrying risks of aspiration, airway blockage, and death from asphyxiation.”

From the early round up of prisoners in Afghanistan and Iraq to the establishment of Guantanamo, medical care, particularly mental health care was woefully inadequate: In Iraq and Afghanistan, evidence shows that clinical medical personnel were not isolated from interrogations as at GuantÃ¡namo; they engaged in various aspects of interrogation as well as other security functions. Physicians reportedly monitored interrogations and psychiatrists signed off on interrogation plans involving sleep deprivation.”

Prisoner abuse went routinely unreported by medical personnel. The report points out that “Even as the use of torture by the military began to decline in 2005 and 2006 when a new DoD interrogation field manual was issued that prohibited the use of many (but not all) highly coercive methods, physicians and nurses became involved in unethical force-feeding and use of restraint chairs in breaking hunger strikes.”

The Department of Defense instituted three “changes in ethical standards and policies to rationalize and facilitate medical and psychological professionals’ participation in interrogation.” Do no harm descended into avoid or minimize harm. Another DoD change “involved conflating ethical standards for health professionals involved in interrogation with general legal standards.”

As hunger strikes — defined as total fasting with only water ingested for more than 72 hours by a mentally competent, non-suicidal person for the purpose of obtaining an administrative or political goal rather than self-harm – became a weapon of the detainees, more health professional became involved in force-feeding sessions.

Ethics Abandoned points out that “International ethical standards and guidelines for treatment established by the World Medical Association and U.S. national medical practice standards guide both physicians and detention facilities responses to hunger strikes. Physicians have the ethical responsibility to determine if a prisoner’s action is indeed a hunger strike; ensure the hunger striking individual’s well-being; determine the individual’s competence to make informed decisions; counsel the individual regarding the consequences and risks of extended food refusal and the options he or she has; determine whether the individual’s decisions are made freely and without coercion; and see to the medical care of the individual during the hunger strike.”

Instead of advocating for the hunger strikers, many of the health providers became involved with force-feeding in restraint chairs, an often violent and painful method. According to the report’s authors, “the force-feeding policies undercut necessary, ongoing physician-patient relationships and independent medical judgment,” and as of the writing of the report, they had not been able to ascertain current policy of hunger strikes, which are continuing.

"We now know that medical personnel were co-opted in ways that undermined their professionalism," said Open Society Foundations President Emeritus Aryeh Neier. "By shining a light on misconduct, we hope to remind physicians of their ethical responsibilities."