The revelation that U.S. interrogators force-fed terrorism suspects through their rectums outraged human-rights activists and doctors, who called it an outdated practice with no legitimate medical rationale.
Rectal feeding was performed on at least five detainees, none with documented conditions that made it medically necessary, according to a report released by Democrats on the Senate Intelligence Committee. Others were also threatened with rectal rehydration, according to cables and records.
While rectal hydration may be used in emergency situations, it’s not the first-, second- or even third-best option, said Allen Keller, director of the Bellevue/New York University Program for Survivors of Torture. It’s clear in the context of the report that there were ulterior motives in the decision to use the technique, he said.
“This was done not solely for therapeutic reasons but as another form of abuse or humiliation,” Keller said. “Given the circumstances, this is sodomy with the intention of humiliation under the guise of medical treatment.”
Central Intelligence Agency interrogators made clear that the practice, justified as a way to hydrate prisoners who refused to eat, wasn’t simply for their health. It was identified as a means of “behavior control” by CIA medical officers that could hasten the end of hunger strikes, according to the documents.
“While IV infusion is safe and effective, we were impressed with the ancillary effectiveness of rectal infusion on ending the water refusal in a similar case,” one of the officers wrote, according to an executive summary of the 6,000-page report, originally approved in December 2012 and now declassified.
The same officer described how the procedure was carried out:
“Regarding the rectal tube, if you place it and open up the IV tubing, the flow will self-regulate, sloshing up the large intestines,” he wrote.
Abd Al-Rahim Al-Nashiri, a Saudi man who was accused of planning the October 2000 attack on the USS Cole that killed 17 sailors, was force-fed rectally after he went on a hunger strike, according to the report. He had refused to eat after accusing the agency of drugging or poisoning his food and has since said he was tortured into confessing his role in seven attacks.
The technique was also used on Khalid Sheikh Mohammed, identified in the report as KSM, a top-ranking al-Qaeda member and the mastermind behind the 9/11 attacks on the U.S.
The chief of interrogations ordered the rectal rehydration, a process he later said showed the interrogator’s “total control over the detainee,” according to the report. The practice was also intended to “clear a person’s head” and encourage Mohammad to talk.
The anecdotes of rectal feeding were part of a litany of harsh procedures detailed in the Senate report on the treatment of terror suspects. In the fall of 2002, a detainee died of hypothermia while shackled to a concrete floor. Another detainee was held for 17 days in the dark without anybody knowing he was there.
“The new details provided by the report regarding the extent and barbarity of torture techniques used by the CIA are sickening and morally reprehensible,” the American Psychological Association said in a statement this week.
The CIA, in a June 2013 response to Senate investigators, said rectal rehydration was a “well acknowledged medical technique,” though it didn’t address rectal feeding. Current CIA Director John Brennan said this week that while the detention and interrogation program had “shortcomings,” it also helped thwart attacks, capture terrorists and save lives.
Rectal feeding or hydration, known as proctoclysis, has been performed for centuries. It is rarely done now, though a 1998 report found water or saline given rectally was safe and effective for terminally ill cancer patients.
The first reports, on papyrus going back 3,500 years, show ancient Egyptians used reeds and animal bladders to infuse liquids like wine and milk into the rectum for a variety of ailments, according to a blog post by Eric Aadhaar O’Gorman, the author of “Complete Tubefeeding.” Perhaps the most famous patient was U.S. President James Garfield, who was fed whiskey and broth rectally after being shot since his doctors restricted what he could eat.
There is no current medical reason to use rectal hydration or nutrition since the rectum is an inefficient way to absorb nutrients, said Ranit Mishori, a family medicine physician at Georgetown University School of Medicine and a consultant for Physicians for Human Rights.
The approach also carries significant risks, including rectal perforation and infection, she said. Intravenous and tube feeding through the nose are more appropriate approaches for nutrition and hydration.
“There is clearly no use or benefit,” she said. “As a physician, I can’t see any justification for this. It’s medical, physiological and psychological torture.”