By Andy Worthington, April 14, 2014
Last Monday, lawyers for Shaker Aamer, 45, the last British resident in the U.S. prison at Guantánamo Bay, Cuba, asked a federal judge to order his release because he is chronically ill. A detailed analysis of Mr. Aamer's mental and physical ailments was prepared by an independent psychiatrist, Dr. Emily A. Keram, following a request in October, by Mr. Aamer's lawyers, for him to receive an independent medical evaluation.
The very fact that the authorities allowed an independent expert to visit Guantánamo to assess Mr. Aamer confirms that he is severely ill, as prisoners are not generally allowed to be seen by external health experts unless they are facing trials. Mr. Aamer, in contrast, is one of 75 of the remaining 154 prisoners who were cleared for release from Guantánamo over four years ago by a high-level, inter-agency task force established by President Obama shortly after he took office in 2009.
As a result, the authorities' decision to allow an independent expert to assess Mr. Aamer can be seen clearly for what it is -- an acute sensitivity on their part to the prospect of prisoners dying, even though, for many of the men, being held for year after year without justice is a fate more cruel than death, as last year's prison-wide hunger strike showed.
In her submission, based on 25 hours meeting with Mr. Aamer from December 16-20, Dr. Keram, an independent psychiatrist who has previously examined other prisoners facing military commission trials, reported and analyzed what Mr. Aamer had told her about his initial detention by the Northern Alliance in Afghanistan in late 2001, his initial imprisonment by the U.S. -- at Bagram and Kandahar in Afghanistan -- and his 12 years at Guantánamo, and her conclusions are that he has Post-Traumatic Stress Disorder (PTSD) and "additional psychiatric symptoms related to his current confinement that are not included in the diagnostic criteria for PTSD but which also gravely diminish his mental health."
The detailed list of his mental ailments is alarming, but Dr. Keram also provided an additional psychiatric prognosis, noting that, "In addition to the psychiatric symptoms discussed above, Mr. Aamer has suffered a profound disruption of his life, dignity, and personhood."
She added: "The length, uncertainly, and stress of Mr. Aamer’s confinement has caused significant disruptions in his underlying sense of self and ability to function. He is profoundly aware of what he has lost. He discussed the struggle he faces if his detention were to continue indefinitely. Additionally, we discussed the struggle he will face, were he to be released, in regaining the ability to function in his family and society. He is aware that it has taken some of the former detainees years to begin to recover to the extent that they have some degree of meaning and productivity in their lives."
That reference to "the length, uncertainty, and stress" of Mr. Aamer's imprisonment reminded me of what Christophe Girod, an official with the International Red Cross, said back in October 2003, when the prison had been open less than two years. Girod said, ''The open-endedness of the situation and its impact on the mental health of the population has become a major problem,'' and it is disturbing to realize how those factors can only have been hideously exacerbated with the passage of 12 years -- not just for Shaker Aamer, but for many, if not most or all of the 154 other remaining prisoners.
In her analysis, Dr. Keram continued: "The chronic and severe psychiatric symptoms described above have gravely diminished Mr. Aamer’s mental health. In order to maximize his prognosis, Mr. Aamer requires psychiatric treatment, as well as reintegration into his family and society and minimization [of] his re-exposure to trauma and reminders of trauma."
Dr. Keram recommended that Mr. Aamer "should receive psychiatric treatment in England in order to obtain meaningful therapeutic benefit," and also stressed that returning him to Saudi Arabia, the country of his birth -- where the U.S. has expressed an interest in returning him, even though he has a British wife and four British children, and was given indefinite leave to remain in the U.K. prior to his capture -- would be disastrous.
As she explained: "The severity of Mr. Aamer’s psychiatric symptoms would worsen were he to be involuntarily repatriated to Saudi Arabia. He reported that should this occur he would not be reunited with his family for many years, if ever. His ongoing separation from his family significantly exacerbates his psychiatric symptoms. Additionally, the impact of a move to Saudi Arabia on his family would likely re-traumatize Mr. Aamer, as his wife and children are unaccustomed to Saudi culture. Finally, Mr. Aamer’s probable further confinement in the Saudi rehabilitation program would likely be re-traumatizing, as its goal would be to re-acclimate him to the norms of Saudi society. Mr. Aamer identifies as a British Muslim and is most comfortable in that culture."
Dr. Keram also analysed Mr. Aamer's extensive physical ailments, which include severe edema (swelling caused by fluid retention in the body's tissues, and also known as dropsy), severe migraines, asthma, chronic urinary retention, otitis media (middle ear infection), tinnitus, GERD (gastroesophageal reflux disease, or acid reflux disease) and constipation.
In reporting the motion filed on behalf of Mr. Aamer, the New York Times helpfully explained that it represented "a new tactic by lawyers seeking the release of Guantánamo detainees by building on a court’s decision last year that a Sudanese detainee should be allowed to leave because of health problems." The Times continued, "Both the Sudanese case and now Mr. Aamer’s focus on laws and regulations governing the repatriation of prisoners of war that could become increasingly important as the detainee population at Guantánamo ages."
The New York Times added: "The law of war permits detaining enemy fighters without trial to prevent their return to the battlefield. But it requires repatriating those who are seriously wounded or sick even before an armed conflict is over. A Geneva Conventions article says detainees shall be repatriated if their 'mental or physical fitness seems to have been gravely diminished' and they seem unlikely to recover within a year.
The Times continued: "A United States Army regulation says wartime detainees who are 'eligible' for repatriation include sick or wounded prisoners 'whose conditions have become chronic to the extent that prognosis appears to preclude recovery in spite of treatment within one year from inception of disease or date of injury."
In the motion submitted last Monday, Mr. Aamer's lawyers argued that he "should be released immediately because his illness has become so chronic that recovery, even with optimal circumstances and care, is precluded within one year, and is likely to take many years or the full course of his remaining natural life."
The New York Times noted that Mr. Aamer’s condition "appears less severe" than that of the Sudanese prisoner, Ibrahim Idris, who was freed in December after the Justice Department refused, for the first time, to challenge a prisoner's habeas corpus petition (Mr. Idris's, in October). Mr. Idris's lawyers had described him as morbidly obese and schizophrenic, and had argued that his "long-term severe mental illness and physical illnesses make it virtually impossible for him to engage in hostilities were he to be released."
However, Ramzi Kassem, a law professor at the City University of New York, whose legal clinic represents Mr. Aamer, refuted the Times's claim about the gravity of Mr. Aamer's illness compared to that of Ibrahim Idris. "The law does not require a prisoner’s total and permanent incapacitation," he said in an interview, adding, "The grave illnesses with which Shaker has now been diagnosed, taken together or separately, meet the legal standard for release under international and domestic law."
Here at "Close Guantánamo," we thoroughly endorse Ramzi Kassem's analysis, and fervently hope that the judge in his case in the District Court in Washington D.C. -- Judge Rosemary Collyer -- agrees.