Fighting “terrorism” with torture

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7393.773 (Published 12 April 2003) Cite this as: BMJ 2003;326:773

Torture is a form of terrorism: there are no justifications for it

  1. Derek Summerfield, honorary senior lecturer (derek.summerfield{at}slam.nhs.uk)
  1. Institute of Psychiatry, King's College, London SE5 8AP

    In the middle ages in Europe torture drew distinction from its association with confessed truth, repentance, and salvation, yet by 1874 Victor Hugo could write “torture has ceased to exist.” But torture was always likely to outlive its obituarists, and Amnesty International has regularly recorded its use in more than half the nations on earth. Is “the war on terrorism” again legitimising torture as it was in the middle ages?

    The accounts of torture victims are horrifying enough but at least these victims survived: Primo Levi reminded us in The Drowned and the Saved that the public record is denuded of the accounts of the drowned.1 In recent years, reflecting the authority imputed to instrumental reasoning and medical arguments, the anti-torture movement has publicised the physical or mental injuries that can result from torture. However, the ordinary citizen does not regard torture as repugnant because it may have medical consequences, but because its use (typically by the state against its own citizens) seems so extreme a violation of the collective values and morality that hold a social fabric together. Indeed the economist and Nobel laureate Amartya Sen points out that torture, political imprisonment, and assassinations seem more shocking and “wrong” than the failure of states to provide basic means of survival, even though such failures cause far greater loss of life.

    Since 11 September 2001 public advocacy of torture no longer seems taboo. The Washington Times recently published a method for the efficient interrogation of Al Qaeda suspect Khalid Shaikh Mohammed, suggested by the president of the Freedom Research Foundation. This involved ventilation by nasal mask of a paralysed subject, with the ventilator turned off to provide transient suffocation whenever the interrogator was dissatisfied.2

    The New York Times and International Herald Tribune last month published apparently well founded accounts of the techniques applied to Abu Zubaydah and other Al Qaeda suspects in US custody. These included deprivation of food, water, sleep, and light; covering subjects' heads with black hoods for hours at a time; forcing them to stand or kneel in unnatural positions in extreme cold or heat; keeping them naked; prolonged chaining or shackling; hooking them up to sensors during serial interrogations; and denial of medical attention. There have been persistent reports of beatings at some US operated centres, and a military pathologist has determined that the deaths of two prisoners at Bagram, Afghanistan, last December were homicides. At Bagram “disorientation is a tool of interrogation and therefore a way of life.” At Guantanamo Bay, Cuba, where around 650 men continue to be held, largely in solitary confinement and beyond the jurisdiction of US law, there have been 20 suicide attempts so far. 3 4

    US officials maintain that the treatment of detainees does not violate international law. They are wrong: this is torture by the definition in the World Medical Association's Declaration of Tokyo (1975): “the deliberate, systematic or wanton infliction of physical or mental suffering, to force another person to yield information, to make a confession, or for any other reason.” It is also in breach of article 5 of the United Nations Declaration of Human Rights: “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.” The UN Committee against Torture ruled in the 1990s that similar practices by Israel—where they were called “moderate physical pressure” and considered legitimate—were indeed torture.5 The UN Committee also denounced the “ticking bomb” defence—the justification that information needs to be obtained quickly to avert an atrocity. Yet this remains the central plank of the argument US officials are using to justify what they are doing. The US is also refusing to support the proposed International Criminal Court unless US citizens have permanent immunity

    The Federal Bureau of Investigation is reportedly to interrogate tens of thousands of Iraqis resident in the USA—25 000 in San Diego alone—under an order from the Justice Department: are we witnessing a re-emergent McCarthyism?6 US leaders and other opinion formers appear to be legitimising a seige mentality and demonisation of the “other” (especially the Muslim other) which risks drawing ordinary citizens into the normalisation of torture and other civil violations in the name of “security.” As a telling example of this, a study of the behaviour of doctors during military dictatorships in Argentina, Chile, and Uruguay concluded that they attended normally to ethical issues like confidentiality, but could collaborate with torture because they saw themselves as patriotic.7 Have the doctors assigned to US interrogation centres protested, for example, at the denial of painkillers to Abu Zubaydah, though he had been shot several times during capture?

    To use torture to fight “terrorism” and to use war to fight “weapons of mass destruction” is perverse: torture is a form of terrorism, and so are the bombs—“shock and awe”—raining down on the citizens of Baghdad as I write. What moral authority can the USA claim in its prosecution of “just” war when it has been the world's major arms manufacturer and exporter to repressive regimes, with the UK not far behind? One of those regimes was, until 1991, Saddam Hussein's Iraq, where extrajudicial execution and torture were always institutionalised.

    Historically torture has targeted the poor and those who spoke for the poor. We need a mature understanding of the felt impact of Western led politics, economics, and culture as globalising forces, and of the stark fact that issues of human rights and social justice have weighed little in the geopolitical and business calculations at play. People without power in the non-Western world, even in their millions, are strategically unimportant and therefore ignorable.8

    In addition to what they do for the individual patient, doctors have a wider duty to speak out about the social and political roots of suffering and disease. It is arguable how seriously the profession en masse—not just Physicians for Human Rights or the medical section of Amnesty International—has taken this part of its remit. After all, the social and economic status of doctors has tended to place them closer to the better off and influential than to those social sectors for whom issues of equity really count. In challenging terroristic violence in all its forms, what is at stake are the imperatives not of medical ethics but of empowered citizenship.


    • Competing interests None declared.


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