“I’m sort of caught between a rock and a hard place,” Ring said. “The Geneva Conventions’ Article III, that says that I have to give the detainees equivalent medical care that I would give to a trooper. But if a trooper got sick, I’d send him home to the United States.

“And so I’m stuck. Whatever I’m going to do, I have to do here.”

For now, with all the detainees healthy enough to get around without assistance, that system is mostly working. Specialists and equipment are flown in as needed, including a handicapped-accessible cell sent to the war-court facility so that a 57-year-old inmate recovering from emergency spinal surgeries could stay overnight at the complex rather than endure transport back and forth from the detention facility.

Officials on the island have been told to expect to keep the lights on for another 25 years. Most of the long-term planning Ring and his successors need to turn Gitmo into a nursing home for terrorists is up to policy makers at the Pentagon—and it’s not clear how much planning has actually been done.

“A lot of my guys are prediabetic. Am I going to do dialysis down here? I don’t know. Somebody has got to tell me that. Are we going to do complex cancer care down here? I don’t know—somebody has got to tell me that,” Ring told reporters.

What is the Pentagon’s plan?

“We’re in the early stages of feeling this out,” Ring said. The long-term goal is to continue to house detainees in communal living configurations, so that they can help care for one another as they age. In the coming months, he is sending a team to study how Federal Bureau of Prisons facilities in the United States handle end-of-life care for elderly prisoners. And eventually the senior medical officer, or SMO, expects to replace the detainee acute-care unit, where surgeons have already performed both emergency and routine elective procedures, to include ramps, grab bars, and other amenities required by the Americans With Disabilities Act.

“This facility was built as sort of a stopgap measure,” the SMO said. “It’s not the final solution. The detainee acute-care unit is designed with a seven-year time frame, so somewhere around 2025, they’re going to have to look at a more permanent solution.”

But experts say that still leaves a lot of unanswered questions about the breadth of care that will be available.

Read: Is closing Guantánamo still conceivable?

“I just can’t imagine being able to configure a suite of [operating rooms]. What you do in a neuro suite versus a cardiac suite are all a bit different. What are you going to do when you decide you’re going to do a cardiac bypass? You need a special OR,” said Stephen Xenakis, a retired military psychiatrist who has worked with Gitmo detainees and now advocates against the use of torture at the nonprofit NGO Physicians for Human Rights. “There’s constraints. And there’s realities. And at the highest levels, there’s going to have to be some very hard decisions.”