Most healthcare professionals will probably never come across a patient who has been subjected to waterboarding, the term used to describe a CIA interrogation technique heatedly debated in recent months by U.S. government officials. But victims who have been waterboarded in the past say the technique causes severe physical pain and often long-lasting psychological stress.
On Feb. 5, the CIA said three suspected al-Qaida terrorists were subjected to waterboarding to gain information about future acts of terrorism following 9/11, according to a story in the Feb. 6 Wall Street Journal. The controversy over waterboarding centers on whether the interrogation technique is a form of torture. Torture is illegal according to U.S. laws. The Bush administration claims waterboarding is not a form of torture because it leaves no physical marks. However, experts on torture, many ethicists, and many members of Congress insist waterboarding is most definitely torture.
But whether it?s termed torture or an enhanced interrogation technique, as it is sometimes referred to by the CIA, the mechanics of waterboarding cause severe physical stress on the body and deep psychological wounds that can last a lifetime, according to healthcare experts interviewed by Nursing Spectrum and NurseWeek.
?That goes without saying,? says Michael Grodin, MD, codirector of the Boston Center for Refugee Health and Human Rights in Boston. Grodin has treated Iraqi and Kurdish citizens who were subjected to waterboarding in the Middle East. The practice is an ?enormously traumatic experience,? he says. ?Everyone who knows anything about medicine would agree.?
Used as a torture technique for more than 900 years, waterboarding can take several forms, but in all cases victims feel as though they are drowning. The following description comes from www.waterboarding.org and is consistent with descriptions of the technique from other sources:
?The interrogation subject is restrained on a board that is then inclined about 15 to 20 degrees so that the feet are above the head. An option is to place a damp cloth over the face to keep the water clinging to the face (Khmer Rouge technique) or put plastic wrap over the mouth but not the eyes or nose to prevent water from escaping the throat and sinuses (CIA technique).
?Pour water onto the inclined face so that the water runs into the upturned mouth and nose. The water stays in the head, filling the throat, mouth, and sinuses with water. The lungs don?t fill up with water so your prisoners don?t asphyxiate, but they do feel their entire upper respiratory system from sinuses to trachea filled with water, ?simulating drowning.? You?re drowning your subjects from the inside, filling their head and neck. The lungs stay out of the water, keeping oxygen in the blood and prolonging the glubbing.?
According to the recently published book Torture and Democracy, by Darius Rejali, an expert on modern torture and a professor of political science at Reed College in Oregon, ?Even a small amount of water in the glottis causes violent coughing, initiating a fight-or-flight response, raising the heart rate and respiratory rate, and triggering desperate efforts to break free. The supply of oxygen available for basic metabolic functions is exhausted within seconds.?
Steven Miles, MD, a medical ethicist, says, ?When you?re waterboarded, you don?t take the type of deep, relaxing breaths that you would for swimming. You?re burning off oxygen much faster, and so while you might be able to swim underwater for 45 seconds, when waterboarded, it only takes 20 seconds to run out of breath. Furthermore, controlling the experience is the hand of someone fundamentally not working in your interest, so you don?t know when you?re coming up and you don?t know what kind of clock you?re working on. They (the torturers) might be timing it with their own breath, which is totally different than the person holding his breath.?
Miles is a professor at the Center for Bioethics and Department of Medicine at the University of Minnesota who has done extensive research into the role of military medical personnel during the Abu Ghraib prison scandal in Iraq in which detainees were tortured by military guards.
The instinctual violent choking in victims of waterboarding causes throat spasms that can damage the esophagus, larynx, and lungs, says Nathaniel Raymond of the Physicians for Human Rights? Campaign Against Torture. Oxygen deprivation can lead to myocardial infarction and possibly death, he adds.
Rejali says although waterboarding only simulates the sense of drowning, the victim will in fact die if the procedure is not stopped in time.
Additional respiratory tissue damage occurs when water enters the lungs, a condition that can lead to infection as well as pulmonary edema.
The binding of limbs to keep victims restrained can cause deep vein thrombosis, Raymond says. Victims can injure their chests, arms, and legs if they struggle against the straps.
The ingestion of large amounts of water into the intestines causes the organs to stretch and convulse causing severe pain, says Rejali.
When the physical stress of suffocation and the fear of death are combined, the result is psychological trauma on par with that of extreme physical torture, says Miles. Research, he says, has demonstrated that the likelihood of developing post-traumatic stress disorder after undergoing psychological torture is the same as if one had undergone physical torture. Victims can develop PTSD and anxiety disorders, become hypervigilant, experience emotional numbing, have flashbacks of being drowned, and develop panic attacks, Miles says.
Boston Center?s Grodin has found that the more often a victim is waterboarded, the more serious and long-lasting the psychological damage.
It is common for victims of waterboarding to acquire associative fears, Raymond says.
?We had one Turkish individual who was waterboarded and who is now unable to go out in the rain and is afraid of showering,? he says.
In some cases, the psychological injuries caused by practices like waterboarding will never completely heal, touching all aspects of survivors? lives.
?A number of torture survivors have a long-lasting inability to form intimate relationships, which affects marriage, families, and the ability to raise kids, but also long-lasting relationships are a key part in the success of working, so this form of withdrawal and non-trust seen in torture survivors is intensely disabling,? Miles says.
Those long-lasting psychological implications become life-long when torture survivors refuse professional help.
?One of the big issues is that you?ve got 40% of torture survivors seeing clinicians who are complicit with the torture ? inspecting them after waterboarding, for example, so the problem is that a lot of torture survivors are afraid of clinicians and disinclined to seek treatment,? Miles says.
Rejali says it is not known if medical professionals are present during waterboarding, including the three cases of the CIA waterboarding terrorist suspects. Says Rejali, ?Who knows what happened? When and if we get all the related documents, we may find out.?
