Our duty to war detainees
AT LEAST 112 detainees have died in US custody in Iraq and Afghanistan between 2002 and 2005, according to military documents and press reports. Many of these deaths appear to have been preventable. Given the public record of detainee abuses and history of weakened administration support of detainee rights, the possibility of preventable deaths in US custody warrants careful review.
Defense Secretary Robert Gates should promptly authorize an independent investigation of possible military negligence and take action to ensure that the United States is living up to its obligations under the Geneva Conventions.
No such wide-ranging and independent inquiry has occurred. Recently, one of us published the most comprehensive, peer-reviewed study of the reported causes of these fatalities in Medscape General Medicine, finding that the leading causes of detainee death were homicide (43 cases) and enemy mortar attacks (36 cases).
According to the study, at least 11 of the 43 homicide cases involved blunt trauma or asphyxiation. At least three of the homicides reported have resulted in murder charges. Another three have resulted in charges of voluntary manslaughter. The 36 deaths caused by enemy mortar attacks, many of which occurred at Abu Ghraib, suggest clear violations of Geneva prohibitions against placing detainees in range of enemy attack.
Also, the study identified 20 deaths that were attributed to natural causes, and nine were listed as having an unknown cause of death. A group of eight deaths due to natural causes occurred in Iraq in August 2003, raising urgent questions about the conditions of confinement and the adequacy and availability of medical care. Given the difficulty in getting information on the deaths of detainees in US custody, and given the sensitivity of the subject, we believe this review is incomplete.
As physicians, we believe that these findings cast doubt on whether our colleagues in the US military caring for detainees are receiving the direction and resources they need to do their job effectively. Health professionals have professional ethical obligations to preserve and protect the lives of their patients. Congress must ensure that our military medical professionals are equipped and supported to accomplish their mission honorably.
America's military medical corps has long been regarded as the most professional and ethical military medical service in the world. As of five years ago, military regulations instructed all uniformed medical personnel to provide medical care to detainees of an equal standard as that received by US soldiers.
After Sept. 11, however, the Pentagon detached the standard of detainee medical care from the standard of care for US personnel deployed in combat theaters. Also, planning for the security and provision of healthcare for detainees taken into custody early on in the Afghanistan and Iraq conflicts was grossly inadequate, as is tragically evident from incidents at Abu Ghraib, Sheberghan prison in Afghanistan, and other US detention centers.
The responsibility for the conduct of the medics at Guantanamo Bay and Abu Ghraib rests with the senior leadership of the medical departments and the Pentagon. Since the onset of combat in both Afghanistan and Iraq, the leadership has faced difficult challenges regarding the appropriate conduct of medics in the treatment of detainees, the way medics handle casualties and deaths of prisoners, and the response to hunger strikes and other medical emergencies in the detention facilities.
The duty and authority for the relevant policies and practices can be neither deferred nor sidestepped. An independent inquiry into detainee deaths is the first step toward ensuring that commanders and policy makers are held accountable for how they treat detainees.
Dr. Scott Allen is a Medicine as Profession Fellow at Physicians for Human Rights. Dr. Stephen Xenakis, a practicing psychiatrist and retired brigadier general, is the former commander of the US Army's Southeast Medical Command. 
