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    Rectal Feeding: The Antiquated Medical Practice the CIA Used for Torture

    Written by

    Brian Merchant

    Senior Editor

    Detainees at Guantanamo Bay. Image: Shane T. McCoy, Wikimedia

    When the CIA 'torture report' was finally declassified, freshly re-outraged Americans were, sadly, familiar with many of the terms—waterboarding, sleep deprivation, abuse—that splashed across headlines and cable news tickers. But there was at least one newly-surfaced atrocity revealed in the report, too. Interrogators had subjected at least five detainees to 'rectal feeding' and 'rectal rehydration,' often against their will. 

    The CIA, it turns out, had administered rectal feedings and hydration both to counteract prisoner hunger strikes and to exercise "behavioral control" over the detainees. 

    The new documents reveal, often in disturbing detail, how the procedure was employed to humiliate and injure inmates at Guantanamo and other detention sites. Khalid Sheikh Mohammed (KSM) was one high-profile recipient of the treatment; it was used on four others, and threatened on even more.

    Rectal rehydration, or proctoclysis, is essentially the act of infusing a patient's rectum with large quantities of fluids through a drip system—it's a century-old technique that rose to prominence during World War I. It was invented by an American surgeon named John Benjamin Murphy (the apparatus is called the Murphy Drip to this day), and was used to both deliver drugs and to keep patients hydrated when they lost use of their mouth.  

    The Murphy Drip. Image Wikimedia

    Over the course of the century, as physicians became more skilled at administering intravenous therapy, the Murphy Drip fell out of regular use. In ​a 2010 article in the journal Emergency Nurse, the author notes that while rectal rehydration is still occasionally used in Chinese medicine to administer herbal remedies, "With the widespread use of intravenous infusions in contemporary emergency nursing, some might question whether there is a place for proctoclysis."

    But the CIA used it anyway, and often.

    "At least five CIA detainees were subjected to 'rectal rehydration' or rectal feeding without documented medical necessity," the torture report explains. 

    This is why.

    "CIA medical officers discussed rectal rehydration as a means of behavior control," the document notes. "As one officer wrote, '[w]hile 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.'" 

    Translation: Administering water and saline through an IV drip worked perfectly well to keep detainees hydrated and fed, but rectal rehydrations had a penchant for degrading prisoners until they ended their hunger strikes.

    For those curious about how the procedure was carried out, allow the CIA to explain: 

    "The same officer provided a description of the procedure, writing that '[r]egarding the rectal tube, if you place it and open up the IV tubing, the flow will self regulate, sloshing up the large intestines ...  [w]hat I infer is that you get a tube up as far as you can, then open the IV wide. No need to squeeze the bag—let gravity do its work.'" 

    And a few other revealing details:

    "The same email exchange included a description of a previous application of the technique, in which 'we used the largest Ewal [sic] tube we had'...  As described in the context of the rectal feeding of al-Nashiri, Ensure was infused into al-Nashiri 'in a forward-facing position (Trendlenberg) with head lower than torso.'"

    It wasn't just hydration; detainees' meals were also liquified and administered rectally, as in the case of Majid Khan. The CIA claims that Khan, who was attempting a hunger strike, had initially cooperated with rectal feeding. But "After approximately three weeks, the CIA developed a more aggressive treatment regimen 'without unnecessary conversation.'"

    Image: Patient with Murphy Drip. Via ​Lecture on Dietetics

    After that, his force-feeding veered towards the inhumane:

    "Majid Khan was then subjected to involuntary rectal feeding and rectal hydration, which included two bottles of Ensure. Later that same day, Majid Khan's 'lunch tray,' consisting of hummus, pasta with sauce, nuts, and raisins, was 'pureed' and rectally infused. Additional sessions of rectal feeding and hydration followed." 

    The humiliation inflicted by such practices apparently took its toll: "In addition to his hunger strikes, Majid Klian engaged in acts of self-harm that included attempting to cut his wrist on two occasions, an attempt to chew into his arm at the inner elbow, an attempt to cut a vein in the top of his foot, and an attempt to cut into his skin at the elbow joint using a filed toothbrush."

    Beyond the drips, the documents show that the CIA had a predilection for violating detainees' rectums.  ​Previously leaked documents showed that agents "sodomized, tortured" a German-born terror suspect back in 2003, and the new report reveals violent behavior during cavity searches:

    "CIA leadership, including General Counsel Scott Muller and DDO James Pavitt, was also alerted to allegations that rectal exams were conducted with 'excessive force' on two detainees at DETENTION SITE COBALT... CIA records indicate that one of the detainees, Mustafa al-Hawsawi, was later diagnosed with chronic hemorrhoids, an anal fissure, and symptomatic rectal prolapse."

    It goes without saying, but all of these detainees who are being routinely rectally violated, have never stood trial. That goes too for the most famous of them, who apparently was administered rectal feedings on more than one occasion. 

    "Chief of Interrogations [redacted] also ordered the rectal rehydration of KSM without a determination of medical need, a procedure that the chief of interrogations would later characterize as illustrative of the interrogator's 'total control over the detainee.'" Furthermore, "On March 5, 2003, KSM was also subjected to additional rectal rehydration," which [redacted] described as helping to "clear a person's head" and effective in getting KSM to talk.

    The CIA, for its part, does not deny the rectal feedings, but claims it was all above board. " The CIA's June 2013 Response does not address the use of rectal feeding with CIA detainees," the report states, "but defends the use of rectal rehydration as a 'well acknowledged medical technique.'"

    Rectal rehydration, is indeed a "well acknowledged medical technique," but it hasn't been widely used for decades. The drip was used as an implement of humiliation, to cause suffering, perhaps even to torture. 

    As the authors of Force-Feeding at Guantánamo: Medical, Legal and Ethical Analysis, "The International Red Cross, the World Medical Association, and the United Nations recognize the right of competent prisoners to go on a hunger strike. All three organizations have labeled force-feeding a violation on the ban of cruel, inhumane, and degrading punishment." 

    The CIA chose not just to force-feed detainees, which could be cruel enough—agents also pushed nutrients through their nasal cavities with nasogastric tubes—but apparently to augment the aggression with a pointedly humiliating tactic. In light of these new documents, it seems painfully clear that the agency turned to an antiquated medical procedure as an excuse to inflict suffering.