Introduction............................................................................................................1Conditions in Camp 6 ............................................................................................3General restrictions on communication with relatives and lawyers ......................6Move to permanent lockdown for most detainees: conditions worse than before.6Standards for humane treatment ..........................................................................11Super-maximum security prisons in the USA .....................................................16Mental health problems and other health concerns..............................................18Recommendations................................................................................................24Appendix: Fair trials and an end to unlawful detentions .....................................26Appendix: Fair trials and an end to unlawful detentions .....................................26

UNITED STATES OF AMERICACruel and Inhuman: Conditions of isolation fordetainees at Guantánamo BayIntroductionWithout question, the isolation of a prisoner from the general population for an indefiniteperiod of time raises Eighth Amendment issues, and due process concerns.US federal judge, 27 August 20041As of 1 April 2007, approximately 385 men of around 30 nationalities were detained withouttrial in the US military base at Guantánamo Bay, Cuba. Designated by the US authorities as“unlawful enemy combatants”, many have been held for more than five years withoutknowing if or when they will be released or brought to any form of judicial process. None ofthose currently held has had the lawfulness of his detention reviewed by a court. A few facethe prospect of trials by military commission under procedures that violate international fairtrial standards.2Amnesty International has raised concerns about the treatment of the detainees eversince the first of them were transferred by plane from Afghanistan to Guantánamo – hooded,shackled and tied down – in January 2002.3From the outset, the US authorities have assertedthat all the detainees in its custody are treated “humanely”. That such assertions should betreated with extreme caution has become clear over the years. Even when officialinvestigations have revealed interrogation techniques and detention conditions that clearlyviolate the international prohibition on torture or other cruel, inhuman or degrading treatment,US investigators and officials have concluded that no law was breached.4Despite being provided with what the US government has called “high quality”medical care, adequate food, sanitation and access to religious items, most detainees havelanguished in harsh conditions throughout their detention, confined to mesh cages or enclosedmaximum security cells. Moreover, in December 2006, a new facility opened on the base.This facility, known as Camp 6, has created even harsher and apparently more permanent

Hamdi v. Rumsfeld,In the US District Court for the Eastern District of Virginia. The EighthAmendment of the US Constitution prohibits, among other things, “cruel and unusual punishments”.2USA: Justice delayed and justice denied? Trials under the Military Commissions Act,AI Index: AMR51/044/2007, March 2007,http://web.amnesty.org/library/Index/ENGAMR510442007.3See, for example,Afghanistan/USA: Prisoners must be treated humanely,AI Index: AMR51/004/2002, 10 January 2002,http://web.amnesty.org/library/Index/ENGAMR510042002;USA: AIcalls on the USA to end legal limbo of Guantánamo prisoners,AI Index: AMR 51/009/2002, 15January 2002,http://web.amnesty.org/library/index/engamr510092002.4For example, seeUSA: Rendition – torture – trial? The case of Guantánamo detainee MohamedouOuld Slahi,AI Index: AMR 51/149/2006, September 2006,http://web.amnesty.org/library/Index/ENGAMR511492006.

conditions of extreme isolation and sensory deprivation in which detainees are confined toalmost completely sealed, individual cells, with minimal contact with any other human being.The US authorities have described Camp 6 as a “state of the art modern facility”which is safer for guards and “more comfortable” for the detainees. However, AmnestyInternational believes that conditions in Camp 6, as shown in photographs or described bydetainees and their attorneys, contravene international standards for humane treatment. Incertain respects, they appear more severe than the most restrictive levels of “super-maximum”custody on the US mainland, where conditions in some units have been criticized byinternational bodies and US courts as incompatible with human rights and US correctionalstandards.The organization isconcerned that, as well as beinginhumane, conditions in Camp 6could have a serious adverseeffect on the psychological andphysical health of many of thedetaineesheldthere,exacerbating the stress inherentin their indefinite detentionwithout trial or access to theirfamilies. Lawyers who haverecently visited Camp 6 haveexpressed concern about theimpact of the conditions on themental state of a number ofdetainees.“Reports indicate that the treatment of detainees since theirarrests, and the conditions of their confinement, have hadprofound effects on the mental health of many of them. Thetreatment and conditions include the capture and transfer ofdetainees to an undisclosed overseas location, sensorydeprivation and other abusive treatment during transfer;detention in cages without proper sanitation and exposureto extreme temperatures; minimal exercise and hygiene;systematic use of coercive interrogation techniques; longperiods of solitary confinement; cultural and religiousharassment; denial of or severely delayed communicationwith family; and the uncertainty generated by theindeterminate nature of confinement and denial of access toindependent tribunals. These conditions have led in someinstances to serious mental illness, over 350 acts of self-harm in 2003 alone, individual and mass suicide attemptsand widespread, prolonged hunger strikes. The severemental health consequences are likely to be long term inmany cases, creating health burdens on detainees and theirfamilies for years to come.”

UN Doc: E/CN.4/2006/120.Situation of detainees at Guantánamo Bay.Report of the Chairperson-Rapporteur of the Working Group on Arbitrary Detention; the Special Rapporteur on the independenceof judges and lawyers; the Special Rapporteur on torture and other cruel, inhuman or degradingtreatment or punishment; the Special Rapporteur on freedom of religion or belief; and the SpecialRapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical andmental health. 27 February 2006.6See, for example, Section 4.2 ofUSA: Human dignity denied – Torture and accountability in the ‘waron terror’,AI Index: AMR 51/145/2004,http://web.amnesty.org/library/index/engamr511452004.Amnesty International April 2007AI Index: AMR 51/051/2007

the International Committee of the Red Cross (ICRC) raised its concern about the “excessiveisolation of detainees”, and noted that there had been “no improvement” on this issue,according to a leaked Pentagon document.8Three and a half years later, in addition to Camp6, Amnesty International remains concerned about other isolation facilities on theGuantánamo base, including Camp 5, built as a long-term detention and interrogation centrewhere detainees classed as “non-compliant” are also held in solitary confinement.At the time of writing, about 300 of the Guantánamo detainees – nearly 80 per cent ofthe current detainee population – were believed to be held in isolation in Camps 5, 6 or CampEcho. According to the Pentagon, 165 detainees had been transferred to Camp 6 from otherfacilities on the base by mid-January 2007. Around 100 detainees are held in Camp 5, andsome 20 more are believed to be held in isolation in Camp Echo, a facility set apart fromothers on the base, which was originally used to hold detainees selected for trial by militarycommissions. Fourteen “high value” detainees transferred from years of secret detention toGuantánamo Bay in September 2006 are also held in isolation on the base, although theirexact location is unknown. It was also not known at the time of writing in which part of thebase Abdul Malik, a detainee transferred from Kenya to Guantánamo over the weekend of24/25 March 2007, was being held.The information in this report is based on various sources including lawyers whohave visited detainees in Guantánamo;9photographs and articles appearing in the press byjournalists given controlled tours of the base (none of whom were allowed to speak todetainees); and public statements and photographs issued by the Department of Defense.Amnesty International has made several requests to visit Guantánamo and speak to detaineessince the detention facility opened in January 2002 but these requests have been turned down.

For example, “[A] point came at which you could notice things changing. That appeared to be afterGeneral Miller around the end of 2002…Before when people were put into isolation they would seemto stay for not more than a month. After he came, people would be kept there for months and monthsand months.” Detention in Afghanistan and Guantanamo Bay. Statement of Shafiq Rasul, Asif Iqbaland Rhuhel Ahmed. July 2004. Available at:http://www.ccr-ny.org/v2/reports/docs/Gitmo-compositestatementFINAL23july04.pdf.8Memorandum for Record. Subject: ICRC Meeting with MG Miller on 09 Oct 03. Department ofDefense, Joint Task Force 170, Guantanamo Bay, Cuba.9Including detailed discussions at Reprieve, a London-based human rights charity which currentlyprovides legal representation for 37 detainees in Guantánamo Bay (see www.reprieve.co.uk). Lawyershave not been allowed into the housing areas of Camps 5 or 6 but only the attorney visitation rooms.

opening windows and detainees are completely cut-off from human contact while inside theircells.The housing cells are arranged around a central area on the ground floor which hasfixed metal tables and chairs, originally designed so that detainees could have communaldining. However, this area was closed off to detainees before the facility opened, following atightening of security and a change in the prison’s mission to one that amounts to anadministrative segregation facility. Detainees now eat all meals inside their cells.The only way in which detainees can communicate with other inmates is by shoutingthrough a narrow gap at the bottom of the cell door. Reportedly detainees have been punishedfor shouting to other inmates. One detainee told his lawyer that after several weeks in thefacility, he still had no idea of who was in the facility apart from the five other inmates in hisimmediate “pod”.Contrary to international standards, the cells have no access to natural light or air, andare lit by fluorescent lighting which is on 24 hours a day and controlled by guards. Thelighting is reportedly dimmed at night, although it is unclear by how much. The only sourceof air in the cells is from air-conditioning controlled by guards. Lawyers who visiteddetainees in January 2007 reported that they consistently complained of being too cold in thesteel cells, with the air-conditioning turned up too high.10One lawyer has described how inthe visiting room her client was huddled on the floor, trying to warm himself with his armsand was too cold to sit on the chair. Reportedly, detainees in Camp 6 have now been giventhermal shirts to wear under their jumpsuits, but these may be taken away as punishmentthrough “loss of privileges”: one detainee reportedly had his shirt taken away when he wasfound with a small item in his pocket when he went to shower.The cells are sparsely furnished with a built-in bunk, and a combined metal toilet andsink unit; some if not all cells also have a small table fixed to the wall near the door with ashelf for the Qu’ran.11Detainees reportedly have no possessions in their cells apart from acopy of the Qu’ran, and (if “compliant”) a prayer rug and beads and one book a week from alibrary cart. The library is reportedly poorly stocked, and there are few books in the Sunnitradition, despite most of the detainees being Sunni; there are a lot of children’s books, andsome which are reportedly culturally insensitive. A clock is reportedly positioned in thecorridor outside the cells so that detainees can see the time for prayer.As well as having few materials or possessions in their cells, detainees are cut offfrom the outside world by not being allowed newspapers, radio or TV. Once a week theguards will reportedly put up articles printed from the internet in the recreation area. AmnestyInternational has been told that these are nearly all in English, which the large majority ofdetainees cannot read. Furthermore, the articles do not constitute any meaningful synopsis ofthe “news” and have sometimes included crude propaganda: a photograph of Saddam Hussain10

was reportedly pinned up at the time of his execution with a caption by the US military statingthat he “was executed because he did not co-operate with the Americans”. On anotheroccasion, captions had reportedly been added to pictures of children along the lines of “Daddy,I don’t remember what you look like. Please cooperate with the Americans so you can comehome”.Detainees are allowed two hours of exercise a day. This is taken in a yard which wasoriginally intended to be a communal sports and recreation area but has now been divided intoindividual areas by chain-link fences. During exercise, detainees are reportedly able to havesome minimal communication with inmates in adjacent areas, although touching, such ashand-shaking, is forbidden. There appears to be no equipment of any kind in the yard forexercise or other activities, apart from a ball in some pens.The exercise yard is surrounded by high concrete walls, with mesh fencing coveringthe top, so that while technically it is an outside area there is no view to the outside. Detaineeshave told their lawyers that, although they can see the sky from the yard during the day, theheight of the walls and the mesh fencing means the sun filters through only for a short periodof the day, and only in patches so that they have little, if any, exposure to the sun.Furthermore, detainees have reported that they are often offered exercise late at night, inwhich case they may not see daylight for days at a time. Guards also reportedly encouragedetainees to refuse yard time at night and take a shower only, to which they usually agree.The lack of human contact in Camp 6 appears to be reinforced by other operatingprocedures. The cell doors are operated by remote control, and guards escorting the detaineesto and from the exercise yard wear thick gloves. There is an opening in the door throughwhich food is slotted so that detainees rarely come into direct contact with another humanbeing. Guards are reportedly silent during most of their contact with detainees. Detainees arealso escorted in shackles whenever they leave their cells. Visits with attorneys take place in asmall, windowless room, and detainees are reportedly shackled to the floor during visits.One common complaint by detainees in Camp 6 is their constant exposure to guards.Several detainees have described their distress at being observed by guards while using the in-cell toilets. Reportedly, detainees in Camp 6 have not been allowed to cover themselves whileusing the toilet and they may be observed by female staff. It is further alleged that, contrary toformer operating rules, female guards now observe detainees while they are taking showers.The towels provided are alleged to be too small to provide adequate covering. AmnestyInternational considers that allowing female guards to watch male detainees in thecircumstances described can amount to a form of sexual abuse in violation of internationalstandards prohibiting cruel, inhuman or degrading treatment; the constant observation mayalso violate the right to privacy and respect for human dignity, both of which are enshrined inthe International Covenant on Civil and Political Rights.Another complaint relates to constant noise deriving from the way Camp 6 isconstructed. The cell areas consist of prefabricated units arranged on two storeys. Cell walls,

General restrictions on communication with relatives and lawyersDetainees in Guantánamo are denied family visits and mail from relatives is often delayed andheavily censored. The father of Guantánamo detainee David Hicks recently said that evenwords of affection were blacked out and removed in letters to and from his son.13Detaineesare generally not allowed any phone calls. In March 2007, Omar Khadr, aged only 16 whenfirst brought to Guantánamo after his capture in Afghanistan in July 2002, was allowed tospeak to his mother on the telephone for the first time in more than five years.Amnesty International has been told that detainees are usually not allowed to keeppaper and pens in their cells and are provided with these items for only half an hour a week; ifthey are unable to complete a letter to their family or lawyer within this period, they have noextra time to do so. This can make it difficult for detainees to communicate with their familiesor lawyers adequately or assist in preparing a legal case, contrary to international standards.14Furthermore, there is no time for detainees to assist those who are illiterate, in areas wherecommunication between detainees is possible.

Move to permanent lockdown for most detainees: conditionsworse than beforeAs noted above, 165 prisoners – more than a third of the total Guantánamo detaineepopulation - had been moved to Camp 6 from other facilities in the base by January 2007.Around 100 other detainees are held in Camp 5, an isolation and interrogation facility for“non-compliant” detainees that opened in October 2004. Amnesty International haspreviously expressed concern about conditions in Camp 5, where detainees (including at leasttwo who were juveniles when taken into custody) have been confined for up to 24 hours a dayin small, enclosed cells. Camp 5 cells appear similar to those in Camp 6 and have solid metaldoors with a small window looking onto an interior corridor; however, they also have a1213

The only area which is not made of steel is the concrete floor on the ground floor cells.Australian national David Hicks is the only detainee known to have had access to family members.14AI was told that detainees may be allowed a pen and paper the day before an annual review boardhearing (an administrative hearing at which the detainee is not represented by a lawyer). Internationalstandards state that prisoners shall be allowed to communicate with family and friends throughcorrespondence and visits (see section on standards). Principle 8 of the UN Basic Principles on theRole of Lawyers states that “All arrested, detained or imprisoned persons shall be provided withadequate opportunities, time and facilities to be visited by and to communicate and consult with alawyer, without delay, interception or censorship and in full confidentiality”.Amnesty International April 2007AI Index: AMR 51/051/2007

narrow frosted window on the outside wall which provides some access to natural light, if noview to the outside. Amnesty International has been told that the exercise yard in Camp 5 issurrounded by fencing so appears less enclosed than in Camp 6. While conditions in bothcamps are extremely harsh, according to a contact who has viewed cells in each facility, thedifference in Camp 6 is that detainees have no way of knowing whether it is day or night fromthe physical environment in the cells. One detainee has described Camp 6 as being a“dungeon above the ground”.15The Pentagon claims that conditions in Camp 6 are superior to those in older housingareas such as Camp 1 as detainees now have more “privacy” and larger cells as well as astandardized two hours of daily exercise. Detainees in Camp 1 are confined to small cages incell blocks, with little opportunity for exercise. Harsh as these conditions are, however, themeshed walls allow communication between detainees as well as access to some natural lightand fresh air (many of the cells appear to have windows). Lawyers have reported thatdetainees formerly in Camp 1, or in Camps 2 and 3 which are similar, find conditions inCamp 6 much more oppressive, particularly in terms of the isolation and lack of natural light.Disturbingly, dozens of detainees transferred to Camp 6 used to be held in Camp 4, amedium security facility where they lived communally in barracks, ate at picnic tables, prayedtogether and had all-day access to an outside recreation area with sports equipment. Theyinclude some or all of the 14 Uighurs who have been cleared by review boards as eligible forrelease but who cannot be returned to China because of the risk of persecution.16Most of theUighurs had been transferred from Camp 4 to Camps 1-3 prior to their transfer to Camp 6;however they had never before been held in conditions of such blanket isolation. They arenow reportedly dispersed among separate pods and are even more isolated as they don’t speakArabic. According to the Department of Defense, as of early March 2007, more than 80 of theapproximately 385 detainees currently held at Guantánamo were designated for release ortransfer, following review board decisions.17A significant number of these may now be held

Declaration of Sabin Willett, January 20, 2007 in case ofHuzaifa Parhat et al v Robert M Gates,before United States Court of Appeals, District of Columbia Circuit, Case No. 06-139716According to their lawyers, Combatant Status Review Tribunal (CSRT) records show that their casehistories are similar to those of five ethnic Uighurs (Chinese Muslims) released from Guantánamo toAlbania in 2006, long after they were determined to be no longer a threat to the USA. The CSRTs areadministrative review bodies set up in July 2004, more than two years after detentions began, to reviewthe “enemy combatant” status of detainees. The CSRT determination is a one-off procedure, followedup by an annual Administrative Review Board (ARB). Both the CSRT and ARB procedures arewholly inadequate replacements for full judicial review of detentions. Both tribunals can rely oncoerced or secret evidence against a detainee denied legal representation and presumed to be an“enemy combatant” unless he can prove otherwise. SeeUSA: Guantánamo and beyond: The continuingpursuit of unchecked executive power,AI Index: AMR 51/063/2005, May 2005,http://web.amnesty.org/library/index/engamr510632005.17News Transcripts from the Department of Defense, 6 March 2007:Annual Administrative ReviewBoards for Enemy Combatants Held at Guantánamo attributable to senior Defense officials.http://www.defenselink.mil/transcripts/transcript.aspx?transcriptid=3902.

in Camps 5 or 6.18It appears that many detainees may have been transferred there becausethere was room in the facility, not because of their individual behaviour.Some of the harshest conditions anywhere at Guantánamo appear to be in Camp Echo.In its meeting with the Guantánamo authorities on 9 October 2003, the ICRC had expressedshock to discover that “Camp Echo had expanded”, and described conditions in the facility as“extremely harsh”.19Camp Echo, which is still operational three and a half years later, is acollection of windowless shacks situated in a separate part of the base. One half of each shackis divided into two small individual cells: a sleeping area and a shower area which thedetainee is reportedly allowed to use for 10 minutes a day. The other half is a room with atable and chairs, which is used for attorney visits and reportedly sometimes for interrogations.Detainees can only access this room by passing through the shower area. Detainees spend 23or 24 hours a day confined to the individual cells at the back of each hut. The huts have nonatural light and fluorescent lighting is on 24 hours a day. Some detainees in Camp Echo havereportedly been denied outdoor exercise for weeks at a time; others have been allowedexercise only a few times a week.Detainees first named toappearbeforemilitarycommissions were at one timeheld in Camp Echo but are nowin Camp 6. For example, afterbeing named as eligible for trialby military commission in 2003,Yemeni national Salim AhmedHamdan was transferred to CampEcho. The military claimed that“detainees at Camp Echo are notin solitary confinement”.20However, Salim Ahmed Hamdanwas held for almost a year insolitary confinement in CampEcho:“TheICRC focussed on the effects that theinterrogations were having on the mental health of thedetainees. The ICRC feels that interrogators have toomuch control over the basic needs of detainees. That theinterrogators attempt to control the detainees throughthe use of isolation. [The ICRC] stated that theinterrogators have total control of the level of isolationin which the detainees were kept; the level of comfortitems detainees can receive; and also the access of basicneeds to the detainees. According to [the ICRC],detainees are kept in uncertainty as to their future andare often given contradictory information about theirrepatriation.”Leaked Department of Defense memorandum of a meetingbetween ICRC and Guantánamo authorities, October 2003.

violent), loneliness, despair, depression, anxiety, and emotional outbursts. Heasserted that he has considered confessing falsely to ameliorate his situation.”21Several detainees who acted as leaders during a brief period of negotiation with theauthorities in 2005 were sent to Camp Echo after negotiations broke down. At least oneformer negotiator, Shaker Aamer, a UK resident, has been held in Camp Echo continuouslysince September 2005 and, at the time of a visit with his attorney in August 2006, had notbeen outside for 64 consecutive days. He has reportedly suffered beatings and harassment byguards and has had his clothes and mattress removed.22Saber Lahmer, another former campnegotiator, was returned to Camp Echo in June 2006 where he remained as of late March2007 without any explanation being given to his attorneys. Both men are reportedly totallyisolated and denied personal possessions and basic materials, such as pen and paper. SaberLahmer was apparently too depressed to see his lawyer during his last visit to the base (seecases, below). Amnesty International has been told that as many as 20 detainees maycurrently be held in Camp Echo, although exact numbers are hard to come by given thefacility’s isolated location.The transfer of most detainees to lockdown conditions marks a shift in policy,reversing moves over the past two years to apply less restrictive conditions for detainees.Following the Abu Ghraib torture revelations and other allegations of detainee abuse,commanders in Guantánamo reportedly began easing conditions for detainees after 2004, withCamp 4 seen as a model and incentive for non-disruptive detainees. The Army reported in2005 that part of the rationale behind the living arrangements in Camp 4 was to rebuilddetainees’ social skills “which may have been lost over time”: to this end detainees wereprovided with social activities and were responsible for maintaining their own livingquarters.23Camp 6 was also reportedly designed to be a medium security facility allowingsocializing among inmates, increased access to exercise areas and activities, mail and foreign-language materials.24The former warden of Guantánamo also started a direct dialogue overdetainee complaints, meeting several times in 2005 with a council of detainee leaders.However, a series of events precipitated a clamp-down by the authorities. Theseincluded the resumption in August 2005 of a hunger strike by detainees in protest at theirindefinite detention and conditions, which continued into January 2006 amid reports of ill-treatment of detainees during force-feeding through nasal tubes. Other incidents were adisturbance in Camp 4 in May 2006;25and the deaths of three prisoners in Camp 1 in June21

Swift v. Rumsfeld,Declaration of Daryl Matthews, M.D., Ph.D., US District Court, Western Districtof Washington, 31 March 2004.22Declaration of Zachary Philip Katznelson (attorney), 19 December 2006. The declaration suggeststhat Shaker Aamer has been treated particularly poorly because he speaks fluent English, is outspoken,and has therefore been an interlocutor between the US military and the detainees.23Article by Kathleen T. Rhem, American Forces Press Service, 16 February 200524See for example,New Guantánamo Camp to Pave Way for Future Detention Ops,by Donna Miles,American Forces Press Service, June 28, 2005.25There are conflicting accounts of what transpired during what the US military calls a “riot” in Camp4 on 18 May, but it appears to have started when a tactical squad entered the camp after two detainees

2006, allegedly from suicide. It was after the deaths that security at Guantánamo appears tohave been dramatically tightened, with the opening of Camp 6 delayed while it was retrofittedas a high maximum security facility. This involved the communal areas in Camp 6 beingclosed off, the landings fenced in and the exercise yard divided into individual pens.Statements by the military indicate that Camps 5 and 6 are intended to be permanentfacilities for the long-term confinement of detainees, with the large majority of detaineeshoused there in the future. According to a military spokesperson, Camp 4 is unlikely to housemany more than the 35 detainees currently held there, down from 180 in May 2006.The US authorities have justified the restrictive regime in Camp 6 by emphasisingthat “the most dangerous” detainees, including those still “intent on killing Americans”, areheld there. Such statements are consistent with a pattern by the administration of presumingthe guilt of detainees who have not been charged or convicted. The authorities maintain thatthe prison combines humane treatment with security needs, citing incidents such as assaultsby detainees on guards with bodily fluids in more open facilities. However, AmnestyInternational considers that conditions in Camp 6 and other isolation facilities areunacceptably harsh and breach international standards for the treatment of persons deprived oftheir liberty.AmnestyInternationalisdisturbed that in applying such punitiveconditions,thegovernmenthasdisregarded the severe psychologicalimpact on detainees of indefiniteconfinement, a concern first raised bythe ICRC more than four years ago.26Such disregard was shown in theauthorities’ description of the apparentsuicides in June as “a good PR move”and an example of “asymmetricalwarfare”. A similar attitude wasdisplayed when officials referred to thehunger strikes as “voluntary fasting”.27Amnesty International believes that the“Hetold me that even when a detainee is beinggood they will take their personal items away. Hesaid they do this to anger the detainees so thatthey can punish them when they object orcomplain. I asked Steven why he treats thedetainees this way. He said it is because he hatesthe detainees and that they are bad people…Steven also added that his ‘only job was to keepthe detainees alive’.”Affidavit of Sergeant Heather N. Cerveny, USMarine Corps, 4 October 2006, relating a discussionshe says she had with a Guantánamo military guard,Steven, who had worked in Camp 5 and wasmoving to Camp 6.

in another part of the base were found to have taken an overdose from hoarded drugs; later on the sameday a detainee in Camp 4 is alleged to have been suspected by guards of preparing to hang himself witha sheet, although this is disputed by detainees. The situation reportedly escalated when some olderdetainees refused to allow their Qu’rans to be searched. Soldiers reportedly used large quantities ofpepper spray and other non-lethal weapons against detainees.26See page 20 ofUSA: The threat of a bad example: Undermining international standards as ‘war onterror’ detentions continue,AI Index: AMR 51/114/2003, August 2003,http://web.amnesty.org/library/pdf/AMR511142003ENGLISH/$File/AMR5111403.pdf.27Guantanamo Tube Feedings Humane, Within Medical Care Standards.American Forces PressService, 1 December 2005,http://www.defenselink.mil/news/newsarticle.aspx?id=18672.Amnesty International April 2007AI Index: AMR 51/051/2007

only way forward is for the US government to restore the rule of law and ensure fairprocedures and humane treatment for all detainees, in accordance with its obligations underinternational law.In raising these concerns, Amnesty International also notes that despite thedisturbances cited above, there are reportedly far fewer violent incidents and assaults on staffthan in the average maximum security prison in the USA. Guantánamo is staffed by militarypolice most of whom have little or no experience in working in prisons or detention facilities;better training and the application of humane standards of treatment would benefit guards aswell as detainees.The United Nations (UN) Committee against Torture has called for the closure ofGuantánamo, concluding that indefinite detention without charge is itself a violation of theConvention against Torture.28Amnesty International is also calling for Guantánamo to beclosed and for the detainees to be charged and tried under international fair trial norms or elsereleased (see appendix). In the meantime, those still detained should be confined in the leastrestrictive and most humane conditions possible.As of March 2007, dozens of detainees are reported to have continued or resumed ahunger strike in protest at their conditions as well as indefinite detention. They includedetainees in Camp Echo and Camps 5 and 6. A number of them were being force-fed throughnasal tubes, some while strapped into restraint chairs. In recently declassified accounts,detainees have described being subjected to considerable pain as the tubes are inserted intotheir nostrils. One detainee reported how, three times, the tube had been inserted the wrongway so that it went into his lungs; he said he frequently vomited after being force-fed and wasnot given clean clothes. Guards have allegedly subjected hunger-striking detainees in oneblock to further punitive treatment, such as pepper spraying them or turning the air-conditioning up high. Amnesty International was seeking further information from theauthorities about these allegations at the time of writing.

Standards for humane treatment“Imprisonmentand other measures which result in cutting off an offender from the outside worldare afflictive by the very fact of taking from the person the right of self-determination by deprivinghim of his liberty. Therefore the prison system shall not, except as incidental to justifiablesegregation or the maintenance of discipline, aggravate the suffering inherent in such a situation”.Article 57 of the United Nations (UN) Standard Minimum Rules for the treatment of Prisoners.“Exceptfor those limitations that are demonstrably necessitated by the fact of incarceration, allprisoners shall retain the human rights and fundamental freedoms set out under the UniversalDeclaration of Human Rights, and, where the State concerned is a party, the InternationalCovenant on Economic and Social Rights, and the International Covenant on Civil and PoliticalRights … as well as such other rights as are set out in other United Nations covenants.”BasicConclusions and recommendations of the Committee against Torture on the USA, 25 July 2006:http://daccessdds.un.org/doc/UNDOC/GEN/G06/432/25/PDF/G0643225.pdf.28

The US government is obliged under international law to treat all those in its custodyhumanely, regardless of their status or location. Since the US Supreme Court ruling inHamdan v. Rumsfeldin June 2006, the US government claims that its treatment of theGuantánamo detainees complies with Article 3 common to the four Geneva Conventions of1949 which prohibits,inter alia,torture, cruel treatment and “outrages upon personal dignity,in particular humiliating or degrading treatment”.29The Detainee Treatment Act of 30December 2005 also prohibits the cruel, inhuman or degrading treatment or punishment, asdefined under US law, of persons of any nationality under the custody or control of the USgovernment anywhere in the world.The US government has declared the Guantánamo detainees to be “unlawful enemycombatants”, a status unrecognized in international law. Under its global “war on terror”paradigm it maintains that its detention activities outside the USA are exclusively regulatedby the law of war, as it defines it, and that human rights law is inapplicable in this globalarmed conflict. However, contrary to this assertion, it is widely agreed by internationalexperts that the two bodies of law, far from being mutually exclusive, are complementary.30As the International Criminal Tribunal for the former Yugoslavia has emphasized,“Theessence of the whole corpus of international humanitarian law as well as humanrights law lies in the protection of the human dignity of every person... The generalprinciple of respect for human dignity is… the very raison d'être of internationalhumanitarian law and human rights law; indeed in modern times it has become ofsuch paramount importance as to permeate the whole body of international law. Thisprinciple is intended to shield human beings from outrages upon their personaldignity, whether such outrages are carried out by unlawfully attacking the body or byhumiliating and debasing the honour, the self-respect or the mental well being of aperson.”31The International Court of Justice (ICJ) has stated that “the protection offered byhuman rights conventions does not cease in case of armed conflict, save through the effect ofprovisions for derogation…”32The USA has made no such derogation.

Common Article 3 reflects customary international law applicable to international and non-international armed conflicts (but does not apply where there is no such conflict).30For further information and discussion, see Section 2 ofUSA: Justice delayed and justice denied?Trials under the Military Commissions Act,AI Index: AMR 51/044/2007, March 2007,http://web.amnesty.org/library/Index/ENGAMR510442007.31Prosecutor v. Furundzija,No. IT-95-17/1-T, Judgment of 10 December 1998, para. 183.32Legal Consequences of the Construction of a Wall in the Occupied Palestinian Territory,AdvisoryOpinion of 9 July 2004, para. 106.http://www.icj-cij.org/icjwww/idocket/imwp/imwpframe.htm.Amnesty International April 2007AI Index: AMR 51/051/2007

Amnesty International considers that the conditions under which detainees are held inGuantánamo contravene universally applicable standards, including international humanrights treaties, and a range of standards and guidelines applying to the treatment of persons incustody.The USA has ratified the International Covenant on Civil and Political Rights(ICCPR) and the Convention against Torture and Other Cruel, Inhuman or DegradingTreatment or Punishment (CAT), both of which prohibit torture and other ill-treatment.Article 10 (1) of the ICCPR requires that “all persons deprived of their liberty shall be treatedwith humanity and with respect for the inherent dignity of the human person”33.The Human Rights Committee, the ICCPR monitoring body, has emphasized that theprohibition on torture and other cruel, inhuman or degrading treatment or punishment is aperemptory norm of international law, non-derogable and binding on all states.34Accordingto the Committee, this absolute prohibition under Article 7 of the ICCPR “relates not only toacts that cause physical pain but also to acts that cause mental suffering ….” and that“prolonged solitary confinement of the detained or imprisoned person may amount to actsprohibited by article 7”35.The Body of Principles for the Protection of All Persons under Any Form ofDetention or Imprisonment (Body of Principles),36states under Principle 6 that:“the term ‘cruel, inhuman or degrading treatment or punishment’ should beinterpreted so as to extend the widest possible protection against abuses, whetherphysical or mental, including the holding of a detained or imprisoned person inconditions which deprive him, temporarily or permanently, of the use of any of hisnatural senses, such as sight or hearing, or his awareness of place of the passing oftime”.Amnesty International believes that the conditions described in Camps 5 and 6 andCamp Echo, particularly when applied long-term or indefinitely, constitute cruel, inhuman ordegrading treatment in violation of the above standards. This conclusion is based on theisolation and prolonged cellular confinement; the conditions inside the cells including the33

In May 2006, the UN Committee Against Torture urged the USA to: “recognize and ensure that theConvention [against Torture] applies at all times, whether in peace, war or armed conflict, in anyterritory under its jurisdiction”. In July 2006, the UN Human Rights Committee called upon the USAto “acknowledge the applicability of the [International] Covenant [on Civil and Political Rights] inrespect of individuals under its jurisdiction and outside its territory, as well as in times of war”34Human Rights Committee, General Comment 29 (States of Emergency, Article 4), UN Doc.CCPR/C/21/Rev.1/Add.11, 31 August 2001.35Human Rights Committee General Comment 20, on Article 7. See also the Basic Principles for theTreatment of Prisoners, Article 7, G. A. res. 45/111 (1990), stating that “Efforts addressed to theabolition of solitary confinement as punishment, or to the restriction of its use, should be undertakenand encouraged”.36While not a treaty, the Principles apply to all countries and represent an authoritative set ofinternationally recognized standards, drafted over a number of years and adopted by consensus by theUN General Assembly in 1988.

enclosed environment and lack of any view to the outside; the lack of access to natural lightand fresh air, particularly in Camp 6; the constant and allegedly intrusive observation; thepaucity of possessions or equipment available to detainees; and the absence of social orexternal stimuli or almost any form of activity, together with minimal contact with the outsideworld.Conditions inside the cellsThe lack of natural light and fresh air in the Camp 6 cells is in clear contravention of the UNStandard Minimum Rules for the Treatment of Prisoners (Standard Minimum Rules), whichstate that“In all places where prisoners are required to live or work, (a) windows shall be largeenough to enable the prisoners to read or work by natural light, and shall be soconstructed that they can allow the entrance of fresh air whether or not there isartificial ventilation.” (Article 11).While the Standard Minimum Rules do not have the binding force of a treaty they areminimum standards considered acceptable for the living conditions and treatment of prisonersworldwide. The rules set out standards for convicted and untried prisoners, and prisoners heldwithout trial, with Article 11 among the rules for general application. Fresh air and naturallight are fundamental elements of the quality of life to which all human beings are entitled.Standards for adult correctional facilities set out by the American CorrectionalAssociation also require that “all inmate rooms/cells provide access to natural light” and anopening window in the case of general population prisoners confined to cells more than 10hours a day.37The ACA standards appear to allow for a natural light source within 20 feet of acell rather than directly into the cell itself. This may be acceptable in old-style facilities wherecells have bars through which light can enter from a central skylight. However, it appears thatno meaningful level of natural light can filter into the enclosed cells in Camp 6 from thecentral area. While the facility was originally designed so that detainees could spend moretime out of their cells, the present lockdown conditions mean that the facility is not meetingACA standards on natural light.The US military authorities reportedly take the ACA standards into account in theoperation of the facility. Although the standards are not mandatory, Amnesty International isdisturbed that the authorities should disregard the standard on access to natural light. Itconsiders this would be unacceptable in any detention facility, and certainly does not conformto what would be required in a facility described as “state of the art”.The cell conditions in Camp Echo, including the lack of window and natural lightalso fall short of ACA and international standards. While the size of the cells in Camps 5 and6 reportedly meet ACA minimum standards, the cells in Camp Echo and Camps 1-3 measurea maximum of six by eight feet. This is considerably less than the minimum 80 square feet of37

total floor space per occupant recommended by the ACA when inmates spend more than 10hours a day in their cells.38The standards also require 35 square feet per prisoner ofunencumbered space, yet the Camp Echo cells reportedly provide only around a third of thisafter the bed, toilet and sink are taken into account. Such a shortfall from minimum standardsis particularly disturbing given the extremely long periods detainees in Guantánamo spend insuch cells.The apparent lack of furniture other than a bed, toilet and sink in isolation cells inGuantánamo, possibly including Camp 6 cells, may also fall short of ACA correctionalstandards.39Amnesty International is also concerned at the possible health risk in requiringdetainees to eat all meals in their cells, given the enclosed environment and close proximity tothe toilet and sink unit. The lack of any chair with a back support may also cause discomfortand physical problems when prisoners are confined to cells for such prolonged periods.The denial of regular outdoor exercise in the case of detainees in Camp Echo andpossibly elsewhere is in breach of the Standard Minimum Rules which state that all prisonersshall have at least one hour of exercise in the open air daily if the weather permits (Rule 21.1).General concernsAll relevant international standards provide that, except for limitations demonstrablynecessitated by the fact of incarceration, prisoners have the same human rights andfundamental freedoms set out under the Universal Declaration of Human Rights and othertreaties. The UN Human Rights Committee reasserts this principle in its General Comment onArticle 10 of the ICCPR that persons deprived of their liberty may not be“… subjected to any hardship or constraint other than that resulting from thedeprivation of liberty; respect for the dignity of such persons must be guaranteedunder the same conditions as for that of free persons. Persons deprived of their libertyenjoy all the rights set forth in the Covenant, subject to the restrictions that areunavoidable in an enclosed environment”, and that:“Treating all persons deprived of their liberty with humanity and with respect fortheir dignity is a fundamental and universally applicable rule … This rule must beapplied without distinction of any kind, such as race, colour, sex, language, religion,political or other opinion, national or social origin, property, birth or other status”.40

While Camp 4 allows detainees to engage in some form of social activity within theconfines of Guantánamo, the absence in Camps 5 and 6 of any social interaction or activitieswhich are a basic part of human life is contrary to the above principle. This is even moredisturbing as all detainees in Guantánamo already suffer through the absence of family visitsor regular contact with the outside world - itself a violation of international standards.The Body of Principles and the Standard Minimum Rules provide that prisonersshould be able to communicate at regular intervals with family and friends both bycorrespondence and by receiving visits.41Cutting a prisoner off from his or her family is alsoa violation of the right to protection of family life contained under the Universal Declarationof Human Rights and article 23 of the ICCPR. The Body of Principles further state that adetained or imprisoned person “shall be given adequate opportunity to communicate with theoutside world, subject to reasonable conditions and restrictions as specified by law or lawfulregulations” (Principle 19), and the Standard Minimum Rules provide that prisoners should bekept informed regularly of what is going on in the outside world, by the reading ofnewspapers, periodicals or other means (Rule 39).In keeping with the general principle that persons deprived of liberty retain the samebasic human rights as non-imprisoned persons, international standards emphasize theimportance of prisoners and detainees engaging in recreational, social, cultural, educationaland religious activities for their mental and physical wellbeing, recognizing that suchmeasures are also necessary to prepare individuals for their eventual return to society.42USfederal rules also emphasize the importance of social, recreational and educational programsfor all inmates in the federal system.43

Super-maximum security prisons in the USACamps 5 and 6 provide a regime similar to those in so-called super-maximum securityfacilities on the US mainland.44These are prisons, or units within prisons, designed for theextended segregation for administrative or disciplinary purposes of prisoners considered tooviolent or too disruptive to be held in the general prison population. Indeed, the conditions inCamps 5 and 6 appear as restrictive as some of the highest security levels in super-maximumunits, some of which have been criticized by US courts. A US federal judge found, forexample, that conditions in Pelican Bay prison in California, where prisoners are confined for4142

Principle 19 of the Body of Principles and article 37 of the Standard Minimum Rules.For example, Principle 28 of the Body of Principles states that a detained or imprisoned person shallhave the right to obtain “reasonable quantities of educational, cultural and informational material”;article 40 of the Standard Minimum Rules states that every institution shall have a library for the use ofall categories of prisoners “adequately stocked with both educational and instructional books”;elsewhere the rules stress the importance of providing prisoners with educational, recreational,religious and vocational programs, with Article 95 stating that all measures applying to convictedprisoners should apply to persons detained without charge “when conducive to the benefit of thisspecial group of persons in custody”.4328 CFR 540.30-34 and 544.80-83.44Some 25,000 prisoners in more than 40 US states are reported to be currently held in such facilities.Amnesty International April 2007AI Index: AMR 51/051/2007

22-23 hours a day to sealed, windowless cells, “may press the outer bounds of what mosthumans can psychologically tolerate”.45International human rights bodies have also criticized conditions in US super-maximum prisons. In his 1999 annual survey of country practices, the UN Special Rapporteuron Torture, for example, raised concern about conditions in two facilities in Indiana, notingthat inmates were held in solitary confinement for 22 and a half hours a day in cells with littlenatural light and fresh air, with most human contact reduced to the minimum. He referred toevidence of the damaging psychological effects of such confinement.46In its May 2000 reporton the USA’s obligations under the Convention against Torture, the Committee againstTorture expressed concern about the “excessively harsh” conditions in US supermaximumprisons and in its report in May 2006 called on the USA to “review the regime imposed” insuch facilities.47In its July 2006 report on US obligations under the ICCPR, the HumanRights Committee reiterated its concern that conditions in some super-maximum securityprisons in the USA were incompatible with Article 10 (1) of the ICCPR.48Inmates assigned to US mainland super-max facilities are usually convicted offenderswho have committed further serious offences or rule violations in prison. While conditionsremain extremely harsh in most super-max facilities, conditions for Guantánamo detainees inCamps 5 and 6 are in some respects even more severe. The detainees are more isolated thanmainland prisoners, for example, in not being allowed even limited visits with familymembers or telephone calls.49Segregated prisoners in the USA must have their statusperiodically reviewed, and some super-max facilities provide a level system where prisonerscan move from the most restrictive custody units to less severe conditions. Some systemsprovide in-cell activities or programs at even the strictest custody levels. In ADX Florence,the only federal super-max (level 6) prison in the USA, prisoners in the “general population”have some group recreation at each of the three security stages; prisoners housed in solitarycells in the Security Housing Unit (SHU) at ADX-Florence are allowed TV, radio and craftmaterials in their cells, unless these are removed for disciplinary purposes.50Detainees inCamps 5 and 6 reportedly have no access to such items. The segregated cells in ADXFlorence have windows giving a view of outside exercise yards.Crucially, inmates of US prisons may seek to have their treatment or conditionsreviewed by the courts or other oversight bodies. Although results have been limited,4546

Madrid v Gomez,889 F. Supp. 1146 (N.D. Cal. 1995).E/CN.4/1999/61 Report of the Special Rapporteur on Torture, 12.01.99.47Conclusions and Recommendations of the Committee against Torture: United States of America.CAT/C/USA/CO/2, 18 May 2006,http://www.ohchr.org/english/bodies/cat/docs/AdvanceVersions/CAT.C.USA.CO.2.pdf.48Human Rights Committee, Concluding Observations: United States of America, 28 July 2006,http://www.ohchr.org/english/bodies/hrc/docs/AdvanceDocs/CCPR.C.USA.CO.pdf.49As noted above, Omar Khadr, who was a juvenile when first detained in Guantánamo, received hisfirst phone call from his family in five years in March 2007. To AI’s knowledge, the vast majority ofdetainees have never received a phone call from their families.50Information from an Amnesty International visit to ADX in July 2001.

litigation has led to the amelioration of conditions in several US super-max facilities.51Inaddition, the US Supreme Court has ruled that prisoners are entitled to procedural safeguardswhen assigned to super-max facilities which impose “atypical and significant hardship”; suchsafeguards include notice of the factual basis for such an assignment and an opportunity torebut the decision at a hearing.52The Guantánamo detainees, on the other hand, have no access to the courts orstatutory oversight bodies and their treatment is entirely at the discretion of the USgovernment. The Military Commissions Act, signed into law by President Bush on 17October 2006, stripped US courts of the jurisdiction to considerhabeas corpusappealschallenging the lawfulness or conditions of detention of any non-US citizen held as an“enemy combatant” in US custody. Although a number ofhabeas corpusapplications havebeen filed on behalf of Guantánamo detainees, and challenges to the new law are pending,none of those currently detained has had his case reviewed by a court. Even before the MCAwas passed, government opposition to briefs filed previously have delayed proceedings overthe years. Judicial review is a vital safeguard against cruel conditions of detention and otherill-treatment as well as arbitrary detention.

Mental health problems and other health concernsThere is a significant body of evidence in the USA and elsewhere that prolonged isolation cancause serious psychological and physical harm, particularly if accompanied by otherdeprivations such as conditions of reduced sensory stimulation, enforced idleness andconfinement to an enclosed space. Sometimes referred to as the “SHU syndrome”, mentalhealth experts who have examined prisoners in isolation, including US super-max facilities,have described symptoms that include perceptual distortions and hallucinations, extremeanxiety, hostility, confusion, difficulty with concentration, hyper-sensitivity to externalstimuli and sleep disturbance as well as physical symptoms.53A study by health experts onprisoners held in isolation units in the UK found inmates suffered from physical disordersresulting from their highly restricted surroundings which included impaired eyesight, weightloss, muscle wastage and memory loss and that some inmates had developed “mental illnesseswhich go beyond the ordinary and expected anticipatory anxiety”.5451

Litigation in Wisconsin led to improvements which included removal of the mentally ill from thestate’s supermax, and substantially reduced the level of lighting in cells at night (Jones’Elv Berge,164F. Supp.2d 1096 (W.D.Wisc 2001); a judicial order in Indiana covered medical and mental healthissues plus access to radios, TVs, additional reading and personal property, increased educationalopportunities and reduced night lighting in cells (Taifav Bayh,946 F. Supp 723 (N.D. Ind 1994).52Wilkinson v Austin,No 04-495, Supreme Court ruling 13 June 2005.53Findings of studies have been described in a number of articles, including Stuart Grassian,“Psychological Effects of Solitary Confinement”,American Journal of Psychiatry,140:1450-1454,1983; Terry A. Kupers, “The SHU Syndrome and Community Mental Health”,Community Psychiatrist,summer 1998, Craig Haney, “Mental Health Issues in Long-Term Solitary and `Supermax’Confinement”,Crime and Delinquency,vol.49, no.1 (January 2003) and in court rulings and testimony.54January 1997 report by three independent psychiatrists who examined prisoners in UK SpecialSecurity Units (SSUs). An official inquiry by the UK Prison Service recommended in an unpublishedAmnesty International April 2007AI Index: AMR 51/051/2007

Several US courts have ruled that the isolating conditions in super-max facilities canlead to serious mental injury in some cases, and have ordered the removal of prisoners withpre-existing mental illness, or who risk developing psychosis, from such units. A judge inWisconsin ruled that confinement under conditions prevailing in the state’s super-max facility“is known to cause severe psychiatric morbidity, disability, suffering and mortality”, even inindividuals with no history of mental breakdown, noting that: “Many prisoners are notcapable of maintaining their sanity in such an extreme and stressful environment: a highnumber attempt suicide”.55The European Committee for the Prevention of Torture and Inhuman or DegradingTreatment or Punishment (CPT), the expert body which is part of the Council of Europe, hasstated, “It is generally acknowledged that all forms of solitary confinement withoutappropriate mental and physical stimulation are likely, in the long-term, to have damagingeffects resulting in deterioration of mental faculties and other social abilities”.56The CPT hasrecommended that all forms of solitary confinement should last for as short a time as possible,with compensatory measures for those held in high security units, such as enhanced exercisefacilities, choice of activities and opportunities to meet fellow inmates within the units.In Guantánamo, detainees generally have not had access to independent, outsidemental health experts.57However, the ICRC noted in 2003 that the totality of the conditionsunder which they were held, including their indefinite confinement, had led to a worryingdeterioration in the psychological health of many detainees. The ICRC continues to expressits concern that “uncertainty about the prisoners’ fate has added to the mental and emotionalstrain experienced by many detainees and their families”.58Lawyers have also reported onhealth problems suffered by detainees, particularly individuals held for prolonged periods insolitary confinement, some of whom had been allegedly subjected to torture or other ill-treatment during interrogation. Complaints about the mental state of detainees appear to haveincreased since the opening of Camp 6. Lawyers who have visited clients in Camp 6 haveconsistently reported a marked decline in the mental and physical health of detainees sincetheir transfer to Camp 6.A document describing the impact on five Uighurs of their transfer to Camp 6 stateshow they all expressed feelings of “despair, crushing loneliness, and abandonment by

report in 1996 that prisoners in SSUs should be held there for as short a period as possible and moreprovision should be made for mental stimulation and physical exercise and that prisoners should haveaccess to open visits with members of their immediate family. The study’s findings are described in anAmnesty International report,UK Special Security Units – Cruel, Inhuman and Degrading Treatment,1997 (AI Index: EUR 45/06/97).55Jones’ El, 164 F. Supp. 2d at 1101, 1102.56CPT Report to the Finnish Government on the Visit to Finland, conducted between 10 and 20 May1992, Strasbourg, France, 1 April 1993, CPT/Inf (93) 8.57David Hicks, an Australian national, had a visit from an Australian psychiatrist in February 2005.Requests for a follow-up visit were reportedly refused by the US authorities.58ICRC, Operational update, 31 December 2006,http://www.icrc.org/web/eng/siteeng0.nsf/html/usa-detention-update-121205?opendocument.

the world”, during visits with their lawyers in January 2007. None had been subjectedto such strict conditions of isolation before. One detainee who during previous visits“had appeared gentle and pleasant, quick to laugh and smile” now “appeared to be indespair” and said he was “beginning to hear voices”. Another described how his cellneighbour was “constantly hearing noises, shouting out, and being punished”.59David Hicks, an Australian national detained for more than five years in Guantánamo,was reported to have deteriorated physically and mentally after being held in virtualtotal solitary confinement in Camps 5 and 6 from March 2006. He was transferred toCamp 6 in December 2006. Lawyers who visited him in January 2007 described howthey were shocked by how much he had changed. Chained to the floor in the Camp 6visitation room, Hicks reportedly looked far older than his 31 years, was hollow-eyed,unkempt and dishevelled and extremely despondent, and had difficulty incommunicating for the first part of the interview. His lawyers said he was sufferingthe effects of prolonged isolation and a lack of privacy, being forced to use the toiletin his cell in full view of the guards. His hairbrush and comb had also beenconfiscated in Camp 6. There were complaints that, in Camp 5, his cell had oftenbeen kept very cold and he had not been given sufficient clothing. Hicks’ family hadexpressed concern about his condition in July 2006, when Hicks had been incoherentduring a telephone call. In December, the US authorities reportedly denied a requestfor a follow-up visit from an independent psychiatrist who had visited Hicks inFebruary 2005.On 26 March 2007, David Hicks pleaded guilty at a military commission hearing inGuantánamo to a single count of “providing material support for terrorism”. On 30March, as part of a pre-trial agreement, he was sentenced to seven years all but ninemonths of which were suspended and was due to be returned to Australia within 60days. .60In January 2007 the lawyer for Bisher al-Rawi, an Iraqi-born UK resident detained inGuantánamo for more than four years, described how his “once healthy andextremely articulate” client was “slowly but surely slipping into madness” after ninemonths of solitary confinement in Camp 5 with no end in sight. Bisher al-Rawi’s cellwas reported often to be “unbearably cold” with the air-conditioning turned up to themaximum. Sometimes guards removed his orange jump suit and sheet, leaving himonly in his shorts. When he tried to warm himself by covering himself with his prayerrug, one of the few “comfort items” permitted to him, guards removed it for “misuse”.His toilet paper was also reportedly removed because he was using it to shield hiseyes from constant light in his cell. He was reportedly being punished with isolation

when he refused to undergo any further interrogations.61In late March 2007 Bisheral-Rawi was transferred to the UK where he was subsequently released.A lawyer for three other Guantánamo detainees reported that they had been“remarkably psychologically strong” and hopeful during a visit in October but twohad later been transferred to Camp 6 and one to Camp 5. During a visit to Camp 6 inJanuary 2007 one of the men who had been vulnerable but bearing up well before,was now “visibly shaken and in great despair”; he had reportedly not seen daylight in15 days.Saber Lahmer, an Algerian transferred to Guantánamo after being seized in Bosnia,has been held in solitary confinement in Camp Echo since late June 2006. A campdoctor had reportedly admitted to him that he needed exercise for serious nervedamage and muscle atrophy in both his legs. However, at Camp Echo he was allowedexercise only every 10 days or so, in a very limited space. When his lawyers visitedhim in November 2006, he appeared both psychologically and physically debilitated,appearing “extremely depressed”, with severe leg pains.62He was completely isolatedfrom anyone but guards as there were no detainees in any adjacent cells; he was notallowed to send or receive mail from his family on a regular basis or to keep mailfrom his lawyers in his cell and was often refused a pen and paper. He was denied allreading material except for the Qu’ran.When his lawyers returned to Guantánamo in March 2007 for a pre-arranged legalvisit with Saber Lahmer guards told them that he did not want to be moved from hiscell to go to an interview. Deeply disturbed that this was a sign of his further mentaldecline, his lawyers sought permission to visit him in his Camp Echo cell or at leastthe visitation room adjoining the cell. This request was also refused. On 22 March,just before they left the base, his lawyers made a formal written request to the CampCommand to move Saber Lahmer from his isolation in Camp Echo to a more socialenvironment. They had not received a response at the time of writing.As noted above, indefinite detention can itself cause severe psychological trauma andthe ICRC has reported at various times on what they have observed to be a deterioration in themental health of a large number of the Guantánamo detainees since January 2002. Twelveindependent mental health experts who examined the impact of indefinite detention on eightdetainees in the UK found this had led to clinical depression in all eight cases as well as signsof depression in three spouses interviewed.63The severe psychological impact of years of6162

Article by al-Rawi’s attorney G. Brent Mickum, in The Guardian, January 9, 2007.His lawyers had administered a proxy examination of him in 2005, which was prepared and thenevaluated by forensic psychologist Dr Daryl Matthews of the University of Hawaii who said that at thattime he met the criteria for a Major Depressive Episode and Post Traumatic Stress Disorder.63The psychiatric problems of detainees under the 2001 Anti-Terrorism Crime and Security Act,Robbins, I., Mackeith, J., Kopelman, M., et al. (2004), Psychiatric Bulletin (2005) 29:407-409, theRoyal College of Psychiatrists.http://pb.rcpsych.org/cgi/content/full/29/11/407.Each of the detaineeswas seen by more than one clinician on more than one occasion and there was a high degree ofconsensus amongst the expert opinion on the detainees.

indefinite confinement and lack of contact with the outside world is likely to be exacerbatedby the conditions of isolation and other deprivations described above. On the US mainland,there is evidence that inmates held in isolation cells, with few amenities or privileges, are at agreater risk of suicide than other prisoners, especially if they already suffer from depressionor other mental health problems.There had been more than 40 attempted suicides by detainees at Guantánamo beforethe three deaths by apparent suicide in June 2006. The men who died were held in maximumsecurity custody in Camp 1. While the physical conditions in Camp 1 meant they were not soisolated as detainees in Camps 5 or 6, they were nevertheless confined to small cells withlittle exercise or amenities, conditions likely to be extremely stressful over time. One of thethree, Yasser al-Zahrani from Saudi Arabia, was only 17 when he was first incarcerated atGuantánamo; he died aged 21. He is among a number of detainees who were under 18 whenfirst held in the base, some of whom had reportedly spent time in isolation or prolongedcellular confinement.64International standards prohibit punishing children with solitary orcellular confinement.65In recognition of the health implications of solitary or isolated confinement, the UNStandard Minimum Rules states that“Punishment by close confinement … shall never be inflicted unless the medicalofficer has examined the prisoner and certified in writing that he is fit to sustain it”(Rule 32 (1)) and that“The medical officer shall visit daily prisoners undergoing such punishments andshall advise the director if he considers the termination or alteration of thepunishment necessary on grounds of physical or mental health” (Rule 32 (3)).ACA standards for correctional facilities also state that inmates in segregation shouldreceive at least daily visits from a qualified health care official.66However, Amnesty International is concerned that the mental or physical health ofGuantánamo detainees in isolation may not be adequately monitored or treated. One detaineesent to Camp 6 reported that he had not been seen by a doctor or mental health professionalmore than two months after being transferred there, despite repeated requests. A detainee inCamp Echo had reportedly not been permitted to see a doctor during two months of solitaryconfinement, despite having health problems (see Saber Lahmar case, below). AmnestyInternational has been told that in general it can be difficult to see a doctor, rather than alower level health technician.Relevant professional and ethical standards require that health professionals inprisons or places of detention should raise any concerns about conditions and their effects on64

prisoners with the authorities. Amnesty International is unaware of whether such action hasbeen taken in regard to conditions of isolation, but notes that mental health and other healthprofessionals at the base are not independent as they are employed by the military. Theorganization is concerned, for example, by reports that military psychiatrists at one timedownplayed some of the suicide attempts at Guantánamo, reclassifying them as “manipulativeself-injurious behaviour”, resulting in a decrease in the number of such attempts officiallyreported.67While detainees in isolation in Guantánamo receive visits by health care technicians,and occasionally by doctors and psychiatrists, they are reportedly assessed only cursorily andsome detainees have stated that they are afraid to complain. Amnesty International has beentold that problems with the delivery of mental health care are compounded by detainees’mistrust of health professionals at Guantánamo because of a history of mental health carepersonnel at the base having worked with interrogators.68Army medical personnel are allegedto have assisted in using detainees’ medical records to design individual prisoner interrogationplans that included sleep deprivation, prolonged isolation and exposure to temperatureextremes, and to have coached interrogators on questioning techniques. Such practices are agross violation of international standards which state that it is a breach of medical ethics forhealth personnel to be involved in any professional relationship with prisoners or detaineesthe purpose of which is not solely to evaluate, protect or improve their physical or mentalhealth.69There are also concerns about the delivery of other medical care. AmnestyInternational is aware of several cases where doctors reportedly advised that detainees neededmore exercise for medical conditions, but the advice was ignored. One case concerned a heartpatient held in restraints in the medical facility and another a detainee transferred to isolation(see Saber Lahmer case, above). Such reports are extremely disturbing and inconsistent withthe US authorities’ claims to provide excellent medical care at Guantánamo. AmnestyInternational is also disturbed at reports that prisoners in the medical facility are routinelyheld in four-point restraint, sometimes for prolonged periods without exercise. Holdingsomeone immobile in restraints for a prolonged period can lead to serious and potentially fatalhealth conditions, including blood clots. The practice is contrary to both international and UShealth professional standards on use of restraints.70

David Rose, Vanity Fair, January 2004.This is based on a number of sources, including a leaked copy of a Department of Defensememorandum relating to an October 2003 meeting between Guantánamo authorities and members ofthe ICRC. Memorandum for Record. Subject: ICRC Meeting with MG Miller on 09 Oct 03.Department of Defense, Joint Task Force 170, Guantanamo Bay, Cuba.69UN Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians, inthe Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or DegradingTreatment or Punishment (adopted by General Assembly resolution 37/194 of 18 December 1982).70For example, in its Standards for Health Services in Correctional Institutions, the American PublicHealth Association (APHA) states that restraints should be used only when inmates pose a great risk ofserious injury to themselves or others and only on the order of a physician; that restraints must be

Jumah al Dossari, a Bahraini national who has reportedly attempted suicide at least 12times during his detention, has been held in the mental health unit at Guantánamo forover a year in a windowless cell. He has told his lawyer that the lights are always offoutside his cell and the air-conditioning turned up high so it is always very cold anddark. His communication with other detainees is reportedly limited because of thesevere psychological problems suffered by many others in the mental health unit,some of whom he has seen crying. After the June 2006 deaths, he was permitted tohave only a blanket, mattress and Qu’ran in his cell, with his possessions increasedsome months later to allow a toothbrush, toothpaste and soap.Although he is visited daily by a psychiatric technician and weekly by twopsychiatrists, they reportedly spend only a few minutes with him, asking the samequestions: whether he is eating and sleeping well, and whether he thinks aboutharming himself or others. He alleges that all detainees have learned to report thatthey are well because otherwise they are held under even stricter conditions.

Saifullah Paracha was moved to the Guantánamo hospital in November 2006 aftersuffering serious chest pains and was diagnosed as needing cardiac catheterization.During the week he spent in hospital he was reportedly held in four-point restraintwith both his hands and both feet chained to the bed at all times (except for one handat meal times). A consulting cardiologist reportedly recommended that SaifullahParacha walk around the hospital four times a day for 20 minutes at a time, butsecurity personnel refused the request. Saifullah Paracha refused to undergo medicaltreatment at Guantánamo as he was not confident that his medical needs would beadequately met or that after the operation he would receive appropriate monitoring.No longer able to tolerate being in restraints, he asked to be returned to his cell inCamp 5 and the doctor agreed.71

and other international instruments relevant to the treatment of persons deprived of liberty. Inparticular, the US government should take immediate steps to:ensure that no detainee is subjected to cruel, inhuman or degrading treatment orpunishment, including prolonged solitary or cellular confinement in conditions ofreduced sensory stimulation. No detainee should be held for a prolonged period in acell with no window to the outside or without access to natural light or fresh air;improve the living conditions for detainees to allow them more association,meaningful activities and recreation; the communal areas in Camp 6 should be fullyutilized. More equipment should be provided in the exercise yards. The library shouldbe better stocked and detainees should have access to recreational and educationalprograms, including through TV and video where feasible, and should be keptinformed regularly of the more important items of news. All detainees should haveregular, daily exercise in the fresh air, during daylight hours;ensure that all detainees are treated with respect for their human dignity; steps shouldbe taken to prohibit intrusive, culturally or sexually humiliating observation ofdetainees, such as allowing female guards to observe detainees while showering;Detainees should be treated with respect for their religious beliefs and practices,including with regard to handling of the Qu’ran;allow independent health care professionals into Guantánamo to examine detainees inprivate;allow visits by independent human rights organizations and the UN specialprocedures. Such visits should include access to all parts of the facility and the abilityof delegates to speak privately with detainees;allow contact with detainees’ families through regular, and where possibleuncensored, mail, with opportunities for phone calls and visits.

Appendix: Fair trials and an end to unlawful detentions

General

721. Any detention facility which is used to hold persons beyond the protection ofinternational human rights and humanitarian law should be closed. This applies to thedetention facility at Guantánamo Bay, where, in more than five years of detentionoperations, the US administration has failed to establish procedures which comply withinternational law and standards. The USA’s secret detention program should beimmediately and permanently ended and any secret detention facilities, wherever in theworld they may be situated, closed down.2. Closing Guantánamo or other facilities must not result in the transfer of the human rightsviolations elsewhere. All detainees in US custody must be treated in accordance withinternational human rights law and standards, and, where relevant, internationalhumanitarian law. All US detention facilities must be open to appropriate externalscrutiny, including that of the International Committee of the Red Cross (ICRC).3. The responsibility for finding a solution for the detainees held in Guantánamo andelsewhere rests first and foremost with the USA. The US government has created asystem of detention in which detainees have been held without charge or trial, outside theframework of international law and without the possibility of full recourse to US courts. Itmust redress this situation in full compliance with international law and standards.4. All US officials should desist from further undermining the presumption of innocence inrelation to the Guantánamo detainees. The continued public commentary on theirpresumed guilt puts them at risk in at least two ways – it is dangerous to the prospect for afair trial and dangerous to the safety of any detainee who is released. It may also putthem at further risk of ill-treatment in detention.5. All detainees must be able to challenge the lawfulness of their detention in anindependent and impartial court, so that that court may order the release of anyone whosedetention is not lawful. The Military Commissions Act should be repealed or substantiallyamended to bring it into conformity with international law, including by fully ensuringthe right tohabeas corpus.6. President George W. Bush should fully rescind his 13 November 2001 Military Orderauthorizing detention without charge or trial, as well as his executive order of 14 February2007 establishing military commissions under the Military Commissions Act.7. Those currently held in Guantánamo should be released unless they are to be charged andtried in accordance with international standards of fair trial.

8. No detainees should be forcibly sent to their country of origin if they would face serioushuman rights abuses there, or to any other country where they may face such abuses orfrom where they may in turn be forcibly sent to a country where they are at such risk.

Fair trials

9. Those to be charged and tried must be charged with a recognizable crime under law andtried before an independent and impartial tribunal established by law, such as a USfederal court, in full accordance with international standards of fair trial. There should beno recourse to the death penalty.10. Any information obtained under torture or other cruel, inhuman or degrading treatment orpunishment should not be admissible in any tribunal. In light of the years of legal,physical and mental abuse to which detainees in US custody have been subjected, anytrials must scrupulously respect international standards and any sentencing take intoaccount the length and conditions of detention in Guantánamo or elsewhere prior to beingtransported there.

Solutions for those to be released

11. There must be a fair and transparent process to assess the situation of each of thedetainees who is to be released, in order to establish whether they can return safely totheir country of origin or whether another solution must be found. In all cases detaineesmust be individually assessed, be properly represented by their lawyers, be providedinterpreters if required, given a full opportunity to express their views, provided withwritten reasons for any decision, and have access to a suspensive right of appeal. Relevantinternational agencies, such as the Office of the United Nations High Commissioner forRefugees (UNHCR), could be invited to assist in this task, in line with their respectivemandates. The options before the US government to deal in a manner which fully respectsthe rights of detainees who are not to be tried and who therefore ought to be releasedwithout further delay include the following:(a)

Return.

The US authorities should return released detainees to their countryof origin or habitual residence unless they are at risk there of serious humanrights violations, including prolonged arbitrary detention, enforceddisappearances, unfair trial, torture or other ill-treatment, extrajudicialexecutions, or the death penalty. Among those who should be released with aview to return are all those who according to the laws of war (GenevaConventions and their Additional Protocols) should have been recognizedafter their capture as prisoners of war, and then released at the end of theinternational armed conflict in Afghanistan, unless they are to be tried for warcrimes or other serious human rights abuses. Again, all detainees who are notto be charged with recognizable crimes should be released.

Diplomatic assurances.

The US authorities must not seek or acceptdiplomatic assurances from the prospective receiving government about howa detainee will be treated after return to that country as a basis for sendingindividuals to countries where they would otherwise be considered at risk of

torture or other ill-treatment. Diplomatic assurances under thesecircumstances breach international human rights obligations; are unreliableand unenforceable; and are inherently discriminatory in that they apply onlyto particular individuals. In addition, the USA must not impose conditionsupon the transfer of detainees under which the receiving state would, byaccepting such conditions, be violating their obligations under internationalhuman rights law.(c)

Asylum in the USA.

The US authorities should provide released detaineeswith the opportunity to apply for asylum in the USA if they so wish, andrecognize them as refugees if they meet the requirements internationalrefugee law. The US authorities must ensure that any asylum applicants haveaccess to proper legal advice and to fair and effective procedures that are incompliance with international refugee law and standards, including theopportunity to contact UNHCR. Asylum applicants should not be detainedexcept in the most exceptional circumstances.

Other forms of protection in the USA.

Persons who do not qualify forrefugee status, but are at risk of serious human rights abuses in theprospective country of return must receive other forms of protection andshould be allowed to stay in the USA if they wish, pursuant to obligationsunder domestic and international human rights law, including theInternational Covenant on Civil and Political Rights, and the Conventionagainst Torture or Other Cruel, Inhuman or Degrading Treatment orPunishment. They should not be detained, unless in each individual case it isestablished before a court that their detention is lawful, for a purposerecognized as legitimate by international human rights law, and necessaryand proportionate to the objective to be achieved, with the lawfulness of thedetention periodically reviewed by the courts, in accordance withinternational human rights law and standards.

Transfer to third countries.

The US authorities should facilitate the searchfor durable solutions in third countries for those who cannot be returned totheir countries of origin or habitual residence, because they would be at riskof serious human rights abuses, and who do not wish to remain in the USA.Any such solution should address the protection needs of the individuals,fully respect all of their human rights, and take into account their views. Alltransfers to third countries should be with the informed consent of theindividuals concerned. UNHCR should be allowed to assist in such a process,in accordance with its mandate and policies. Released detainees should not besubjected to any pressures and restrictions that may compel them to choose toresettle in a third country. Transfers must not occur to third countries fromwhere individuals may in turn be forcibly sent to a country where they wouldbe at such risk.

Reparations

12. The USA has an obligation under international law to provide prompt and adequatereparation, including restitution, compensation, rehabilitation, satisfaction, and fair andguarantees of non-repetition, to released detainees for the period spent unlawfullydetained and for other violations that they may have suffered, such as torture or other ill-treatment. The right of victims to seek reparations in the US courts must not be limited.

Transparency pending closure

13. The USA should invite the five UN experts who have sought access – the SpecialRapporteur on torture and other cruel, inhuman or degrading treatment or punishment, theSpecial Rapporteur on the independence of judges and lawyers, the Special Rapporteur onfreedom of religion or belief, the Special Rapporteur on the right of everyone to theenjoyment of the highest attainable standard of physical and mental health, and theChairperson-Rapporteur of the Working Group on Arbitrary Detention – to visitGuantánamo without the restrictions that led them to turn down the USA’s previousinvitation. In particular, there should be no restrictions on the experts’ ability to talkprivately with detainees.

Other countries

14. Other countries should give serious consideration to accepting released detaineesvoluntarily seeking resettlement there, especially countries of former habitual residence orcountries where released detainees have had close family or other ties.15. Other governments should reject conditions attached to detainee transfers requested bythe USA which would violate the receiving country’s obligations under internationalhuman rights law.16. All countries should actively support closure of the Guantánamo detention camp and allother facilities operating outside the rule of international human rights and humanitarianlaw, and an end to secret detentions and interrogations.17. No state should transfer anyone to US custody in circumstances where they could bedetained in Guantánamo or elsewhere where they may be held outside the protections ofinternational law, or in cases where they could face trial by military commission.18. No state should provide any information to assist the prosecution in military commissiontrials. This applies in all instances, and is especially compelling in cases where the deathpenalty is sought..