When War Comes: Why Don’t We Plan Better for Detainee Medical Care?

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Iraqi boys in front of a mural showing the Statue of Liberty and Abu Ghraib's most infamous photograph / Photo by Awad Awad/AFP/Getty

In just about every war, the military ends of taking care of prisoners of war (POWS) or other detainees. However, military medical providers receive very little standardized training on detainee care. Why don’t we train better for that?

I am recently back from teaching at a course on the Law of Armed Conflict in Switzerland. This is essentially a training exercise on the intersection of medicine, ethics and war. The 12-day course brings together military medical officers from all specialties and many countries to focus on the Law of War, the Geneva Convention, and other matters related to safeguarding the rights of combatants, non-combatants , POWs and detainees. I last taught in the course in 2004, shortly after the Abu Ghraib scandal began. It was uncomfortable then. I had a tough time with the Swiss and French questioning me about the scandals at Abu Ghraib and with the interrogation of detainees.  I had no explanations then.  The horrid pictures were impossible to minimize.

The reality is that medical staff are seldom prepared in advance for the care of detainees. I saw this over and over again. It is not their fault. Medical staff arrive in the middle of the combat zone and suddenly are told they will be caring for this population, often very sick or wounded — and hostile.

Medics, by and large, are not trained in how to protect themselves or their patients.  They do get training about the Geneva Convention, but there are many more complicated issues. We saw this in the Korean War and others; it is not limited to the conflicts since 9/11. Therefore we should have learned to prepare better by now.

After the Abu Ghraib scandal, medics received instructions warning them not to abuse detainees. By and large, that was wasted. Medical staff rarely abuse detainees. What is needed training on is how to advocate for both quality medical care and security measures for the detainees.

What do I mean by that? If you are the only social worker, with no psychiatrist or psychologists, at Camp Bucca with 20,000 detainees, how do you provide quality mental-health care? If you are a physician assistant at Abu Ghraib, with no CT scanner, how do you take care of head trauma?

There are some exceptions. The Navy has developed a good course for training medical staff going down to Guantanamo Bay (GTMO). There have been periodic just-in-time trainings for hospital staff going over to Iraq and Afghanistan. But, other than a few examples, this course on the Law of Armed Conflict is a rare example of these discussions.

In the newly available Combat and Operation Behavioral Health Textbook of Military Medicine there is a great chapter on taking care of detainees. The chapter can be downloaded, for free, here on the Borden Institute website.

The medics who are serving in these positions do the best they can, under very difficult circumstances.  Let us not repeat the scandals of the past. We know that every war produces POWs, detainees or both. Quality detainee health care should be part of the regular curriculum of every military provider.