As I wrote ages ago, an idiot could write a play set in Abu Ghraib. A playwright should write a story for the ages.
In the meantime, two researchers write in the New York Times about an Abu Ghraib inquiry they conducted for NEJM. The bottom line: A general should take the heat. Ideally Rumsfeld should, but that's only in an alternate reality. (For the uninitiated, running out of chest tubes is a bad sign. These are used when someone's has an open chest wound, often from a sharp object.)
... During an inquiry we conducted for The New England Journal of Medicine, the doctor, Maj. David Auch, told us that some of the prisoners at Abu Ghraib were psychotic and out of control. One, he said, would repeatedly strip off his clothes and smash his head against the wall. After handcuffs and a helmet failed to stop him and with straitjackets unavailable, some soldiers suggested the leash. Major Auch granted their request. "My concern was whatever it took to keep him from getting hurt," he said.
It is easy to criticize Major Auch for allowing M.P.'s to use a leash, but it is difficult to say what he should have done instead. He had antipsychotic drugs on hand but no psychiatrists to prescribe them, and he lacked the experience to give these powerful drugs himself.
So the leashed detainee went untreated, as did hundreds of others with mental disorders. The lone psychologist who accompanied Major Auch, First Lt. Joseph Wehrman, was troubled by what he found on their weekly visits. Up to 5 percent of the detainee population (which averaged 2,000 in late 2003 and early 2004) was mentally ill, Lieutenant Wehrman told us, but to his knowledge, none of the prisoners received medication.
The atmosphere at Abu Ghraib hardly promoted sanity. Mortar shells landed almost daily, according to military personnel we interviewed, and prisoners often rioted, sometimes using smuggled weapons, with deadly effect. In late 2003, Major Auch's unit set up a field hospital, bringing a full-time medical presence to the prison for the first time. For the dozen or so clinicians assigned to the hospital, the daily routine was surreal.
At times the hospital lacked basic supplies, according to members of the clinical staff, and at times it maintained a surgical service without surgeons. Sometimes the hospital ran out of chest tubes, intravenous fluids or medicines. Medical staff members improvised, taking tubes from patients when they died and reusing them, without sterilization.
Physician's assistants and general practitioners amputated limbs, a dentist did heart surgery, and Major Auch begged and bartered with other medical units for drugs and intravenous fluids. When they ran out of blood sugar test strips for Abu Ghraib's many diabetics, according to a medic assigned to the unit, they gave insulin by guessing the dose and watching for bad reactions.
Amid murderous shortages, there were paradoxes of plenty. Major Auch's men received sophisticated equipment like digital X-ray machines, several said, but they weren't taught how to use it. And in fact, a psychiatrist was assigned to Abu Ghraib for a few months. But he treated no patients; that wasn't his job. He was supposed to help military intelligence make interrogation plans....
...But we are not inclined to blame Major Auch. The men and women who risked their lives to care for Iraqis and Americans alike were put in impossible circumstances by indifference or worse from above.
... at Abu Ghraib, the Army all but abdicated its responsibility to provide care to the thousands of people it kept in custody. This neglect bred dire conditions and desperate measures.
The catastrophic failings of medical care at Abu Ghraib put American lives at risk and violated the United States' obligations to care decently for detainees. The soldiers who snapped and posed for the photos of abuse are being called to account. But the focus on their culpability diverts attention from the causal relationship between the Pentagon's priorities and the hellish conditions that both prisoners and their captors endured. This larger story, of conditions that ensured neglect and invited cruelty, is being ignored.
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