"Pharmacologic Waterboarding" at Guantanamo

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"Pharmacologic Waterboarding" at Guantanamo

Postby American Dream » Thu Dec 02, 2010 2:19 pm

http://www.truth-out.org/controversial- ... arding6558

EXCLUSIVE: Controversial Drug Given to All Guantanamo Detainees Akin to "Pharmacologic Waterboarding"
Wednesday 01 December 2010
by: Jason Leopold and Jeffrey Kaye, t r u t h o u t | Investigative Report



The Defense Department forced all "war on terror" detainees at the Guantanamo Bay prison to take a high dosage of a controversial antimalarial drug, mefloquine, an act that an Army public health physician called "pharmacologic waterboarding."

The US military administered the drug despite Pentagon knowledge that mefloquine caused severe neuropsychiatric side effects, including suicidal thoughts, hallucinations and anxiety. The drug was used on the prisoners whether they had malaria or not.

The revelation, which has not been previously reported, was buried in documents publicly released by the Defense Department (DoD) two years ago as part of the government's investigation into the June 2006 deaths of three Guantanamo detainees.

Army Staff Sgt. Joe Hickman, who was stationed at Guantanamo at the time of the suicides in 2006, and has presented evidence that demonstrates the three detainees could not have died by hanging themselves, noticed in the detainees' medical files that they were given mefloquine. Hickman has been investigating the circumstances behind the detainees' deaths for nearly four years.

Interviews with mefloquine and malaria experts and a review of peer-reviewed journals and government documents show there were no preexisting cases where mefloquine was ever prescribed for mass presumptive treatment of malaria.

All detainees arriving at Guantanamo in January 2002 were first given a treatment dosage of 1,250 mg of mefloquine, before laboratory tests were conducted to determine if they actually had the disease, according to a section of the DoD documents entitled "Standard Inprocessing Orders For Detainees." The 1,250 mg dosage is what would be given if the detainees actually had malaria. That dosage is five times higher than the prophylactic dose given to individauls to prevent the disease.

Maj. Remington Nevin, an Army public health physician, who formerly worked at the Armed Forces Health Surveillance Center and has written extensively about mefloquine, said in an interview the use of mefloquine "in this manner ... is, at best, an egregious malpractice."

The government has exposed detainees "to unacceptably high risks of potentially severe neuropsychiatric side effects, including seizures, intense vertigo, hallucinations, paranoid delusions, aggression, panic, anxiety, severe insomnia, and thoughts of suicide," said Nevin, who was not speaking in an official capacity, but offering opinions as a board-certified, preventive medicine physician. "These side effects could be as severe as those intended through the application of 'enhanced interrogation techniques.'"

Mefloquine is also known by its brand name Lariam. It was researched by the US Army in the 1970s and licensed by the Food and Drug Administration in 1989. Since its introduction, it has been directly linked to serious adverse effects, including depression, anxiety, panic attacks, confusion, hallucinations, bizarre dreams, nausea, vomiting, sores and homicidal and suicidal thoughts. It belongs to a class of drugs known as quinolines, which were part of a 1956 human experiment study to investigate "toxic cerebral states," as part of the CIA's MKULTRA mind-control program.

The Army tapped the Walter Reed Army Institute of Research (WRAIR) to develop mefloquine and it was later licensed to the Swiss pharmaceutical company F. Hoffman-La Roche. The first human trials of mefloquine were conducted in the mid-1970s on prisoners, who were deliberately inoculated with malaria at Stateville Correctional prison near Joliet, Illinois, the site of controversial antimalarial experimentation in the early 1940s.

The drug was administered to Guantanamo detainees without regard for their medical or psychological history, despite its considerable risk of exacerbating pre-existing conditions. Mefloquine is also known to have serious side effects among individuals under treatment for depression or other serious mental health disorders, which numerous detainees were said to have been treated for, according to their attorneys and published reports.

In 2002, when the prison was established and mefloquine first administered, there were dozens of suicide attempts at Guantanamo. That same year, the DoD stopped reporting attempted suicides.

By February 2002, there were at least 459 detainees imprisoned at Guantanamo. In March of that year, according to the book "Saving Grace at Guantanamo Bay: A Memoir of a Citizen Warrior" by Montgomery Granger, "the situation" at the prison began "deteriorating rapidly."

"There is more and more psychosis becoming evident in detainees ...," wrote Granger, an Army Reserve major and medic who was stationed at Guantanamo in 2002. "We already have probably a dozen or so detainees who are psychiatric cases. The number is growing."

"Presumptively Treating" Malaria

Though malaria is nonexistent in Cuba, DoD spokeswoman Maj. Tanya Bradsher told Truthout that the US government was concerned that the disease would be reintroduced into the country as detainees were transferred to the prison facility in January 2002.

A "decision was made," Bradsher said in an email, to "presumptively treat each arriving Guantanamo detainee for malaria to prevent the possibility of having mosquito-borne [sic] spread from an infected individual to uninfected individuals in the Guantanamo population, the guard force, the population at the Naval base or the broader Cuban population."

But Granger wrote in his book that a Navy entomologist was present at Guantanamo in January and February 2002 and during that time only identified insects that were nuisances and did not identify any insects that were carriers of a disease, such as malaria.

Nevertheless, Bradsher said the "mefloquine dosage [given to detainees] was entirely for public health purposes ... and not for any other purpose" and "is completely appropriate."

"The risks and benefits to the health of the detainees were central considerations," she added.

But a September 13, 2002, DoD memo governing the operational use of mefloquine said, "Malaria is not a threat in Guantanamo Bay." Indeed, there have only been two to three reported cases of malaria at Guantanamo.

The DoD memo, signed by Assistant Secretary of Defense for Health Affairs William Winkenwerder, was sent to then-Rep. John McHugh, the Republican chairman of the House Veterans Affairs Subcommittee on Military Personnel. McHugh is now Secretary of the Army.

A Senate staff member told Truthout the Senate Armed Services Committee was never briefed about malaria concerns at Guantanamo nor was the committee made aware of "any issue related to the use of mefloquine or any other anti-malarial drug" related to "the treatment of detainees."

When questions were raised at a February 19, 2002 meeting of the Armed Forces Epidemiological Board (AFEB) about what measures the military was taking to address malaria concerns at Guantanamo, Navy Capt. Alan J. Lund did not disclose that mefloquine was being administered to detainees as a form of presumptive treatment.

Yund said the military gave detainees a different anti-malarial drug known as primaquine and noted that "informed consent" was "absolutely practiced" prior to administering drugs to detainees, an assertion that contradicts claims made by numerous prisoners who said they were forced to take drugs even if they protested. Yund did not return calls for comment.

Bradsher declined to respond to a follow-up question about who made the decision to presumptively treat detainees with mefloquine.

An April 16, 2002, meeting of the Interagency Working Group for Antimalarial Chemotherapy, which DoD, along with other federal government agencies, is a part of, was specifically dedicated to investigating mefloquine's use and the drug's side effects. The group concluded that study designs on mefloquine up to that point were flawed or biased and criticized DoD medical policy for disregarding scientific fact and basing itself more on "sensational or best marketed information."

The Working Group called for additional research, and warned, "other treatment regimes should be carefully considered before mefloquine is used at the doses required for treatment."

Still, despite the red flags that pointed to mefloquine as a high-risk drug, the DoD's mefloquine program proceeded.

In fact, a June 2004 set of guidelines issued by the Centers for Disease Control and Prevention (CDC) says mefloquine should only be used when other standard drugs were not available, as it "is associated with a higher rate of severe neuropsychiatric reactions when used at treatment doses."

According to the CDC, "'presumptive treatment' without the benefit of laboratory confirmation should be reserved for extreme circumstances (strong clinical suspicion, severe disease, impossibility of obtaining prompt laboratory confirmation)."

A CDC spokesman refused to comment about the "presumptive treatment" of malaria at Guantanamo and referred questions to the DoD.

Nevin said, if "mass presumptive treatment has been given consistently, many dozens of detainees, possibly hundreds, would almost certainly have suffered such disabling adverse events."

"It appears that for years, senior Defense health leaders have condoned the medically indefensible practice of using high doses of mefloquine ostensibly for mass presumptive treatment of malaria among detainees from the Middle East and Asia lacking any evidence of disease," Nevin said. "This is a use for which there is no precedent in the medical literature and which is specifically discouraged among refugees by malaria experts at the Centers for Disease Control."

Even proponents of limited mefloquine usage are seriously questioning the logic behind the DoD's actions. Professor James McCarthy, chair of the Infectious Diseases Division of the Queensland Institute of Medicine in Australia, who is an advocate of the safe use of mefloquine under proper safeguards, and takes it himself when traveling, told Truthout he was unaware of the use of mefloquine for mass presumptive treatment as described by the DoD, but could imagine it under certain circumstances.

However, when informed that lab tests were available and the detainees were screened for the blood product G6PD, used to determine the suitability of certain antimalarial drugs, McCarthy found the DoD's use of mefloquine at Guantanamo difficult to understand and "hard to support on pure clinical grounds as an antimalarial."

Treatment, Torture or an Experiment?

Another striking point about the DoD's decision to presumptively treat mostly Muslim detainees with mefloquine beginning in 2002 is that it is the exact opposite of how the DoD responded to malaria concerns among the Haitian refugees who were held at Guantanamo a decade earlier.

Between 1991 and 1992, more than 14,000 Haitian refugees were held in temporary camps set up at Guantanamo. A large number of Haitian refugees - 235 during a four-month period - werediagnosed with malaria. But instead of presumptively treating the refugee population at Guantanamo, the DoD conducted laboratory tests first and only the individuals who were found to be malaria carriers were administered chloroquine.

Another example of how the DoD approached malaria treatment differently for other subjects is in the case of Army Rangers who returned from malarial areas of Afghanistan between June and September 2002 and were infected with the disease at an attack rate of 52.4 cases per 1,000 soldiers.

However, the Rangers did not receive mass presumptive treatment of mefloquine. They were given other standard drugs after laboratory tests, according to documents obtained by Truthout.

Nevin said the DoD's treatment of Haitian refugees represented "a situation that arguably presented a much higher risk of disease and secondary transmission, but one which US medical experts stated at the time could be safely managed through more conservative and focused measures."

Why did the government use the "conservative and focused" approach in treating Haitian refugees and the Army rangers, but then revert to presumptive mefloquine treatment in the case of the Guantanamo detainees, who - a month after the prison facility opened in January 2002 - were stripped of their protections under the Geneva Conventions?

According to Sean Camoni, a Seton Hall University law school research fellow, "there is no legitimate medical purpose for treating malaria in this way" and the drug's severe side effects may actually have been the DoD's intended impact in calling for the drug's usage.

Camoni and several other Seton Hall law school students have been working on a report about mefloquine use on Guantanamo detainees. Their work was conducted independently of Truthout's investigation.

A copy of the Seton Hall report, "Drug Abuse? An Exploration of the Government's Use of Mefloquine at Guantanamo," says mefloquine's extreme side effects may have violated a provision in the antitorture statute related to the use of "mind altering substances or other procedures" that "profoundly disrupts the senses or the personality."

Legal memos prepared in August 2002 by former DoD attorneys Jay Bybee and John Yoo for the CIA's torture program permitted the use of drugs for interrogations. The authority was also contained in a legal memo Yoo prepared for the DoD less than a year later after Secretary of Defense Donald Rumsfeld convened aworking group to address "policy considerations with respect to the choice of interrogation techniques."

In September, Truthout reported that the DoD's inspector general (IG) conducted an investigation into allegations that detainees in custody of the US military were drugged. The IG's report, which remains classified, was completed a year ago and was shared with the Senate Armed Services Committee.

Kathleen Long, a spokeswoman for the Armed Services Committee, told Truthout at the time that the IG report did not substantiate allegations of drugging of prisoners for the "purposes of interrogation."

The medical files for detainee 693 released in 2008 shows that, two weeks after he first started taking mefloquine in June 2002, he was interviewed by Guantanamo medical personnel and reported he was suffering from nightmares, hallucinations, anxiety auditory and visual hallucinations, anxiety, sleep loss and suicidal thoughts.

The detainee said he had previously been treated for anxiety and had a family history of mental illness. He was diagnosed with adjustment disorder, according to the DoD documents. Guantanamo medical staff who interviewed the detainee did not state that he may have been experiencing mefloquine-related side effects in an evaluation of his condition.

Mark Denbeaux, the director of the Seton Hall Law Center for Policy and Research, who conducted an independent investigation into the 2006 deaths of the three Guantanamo detainees, said in an interview "almost every remaining question here would be solved if the [detainees'] full medical records were released."

The government has refused to release Guantanamo detainees' medical records, citing privacy concerns in some cases, and assertions that they are "protected" or "classified" in other instances. The few medical records that have been released have been heavily redacted.

"A crucial issue is dosage" Denbeaux said. "Giving detainees toxic doses of mefloquine has mind-altering consequences that may be permanent. Without access to medical records, which the government refuses to release, the use of mefloquine in this manner appears to be grotesque malpractice at best, if not human experimentation or 'enhanced interrogation.' The question is where are the doctors who approved this practice and where are the medical records?"

Bradsher did not respond to questions about whether the government kept data about the adverse effects mefloquine had on detainees.

An absolute prohibition against experiments on prisoners of war is contained in the Geneva Conventions, but President George W. Bush stripped war on terror detainees of those protections. Some of the "enhanced interrogation techniques" also had an experimental quality.

At the same time detainees were given high doses of mefloquine, Deputy Secretary of Defense Paul Wolfowitz issued a directivechanging the rules on human subject protections for DoD experiments, allowing for a waiver of informed consent when necessary for developing a "medical product" for the armed services. Bush also granted unprecedented authority to the secretary of Health and Human Services to classify information as secret.

Briefings on Side Effects

As the DoD was administering mefloquine to Guantanamo prisoners, senior Pentagon officials were being briefed about the drug's dangerous side effects. During one such briefing, questions arose about what steps the military was taking to address malaria concerns among detainees sent to Guantanamo.

Internal documents from Roche, obtained by UPI in 2002, indicated that the pharmaceutical company had been tracking suicidal reactions to Lariam going back to the early 1990s.

In September 2002, Roche sent a letter to physicians and pharmacists stating that the company changed its warning labels for mefloquine.

Roche further said in one of two new warning paragraphs that some of the symptoms associated with mefloquine use included suicidal thoughts and suicide and also "may cause psychiatric symptoms in a number of patients, ranging from anxiety, paranoia, and depression to hallucination and psychotic behavior," which "have been reported to continue long after mefloquine has been stopped."

Military Struggles

Cmdr. William Manofsky, who is retired from the US Navy and currently on disability due to post-traumatic stress disorder and side effects from mefloquine, said those are some of the symptoms he initially suffered from after taking the drug for several months beginning in November 2002 after he was deployed to the Middle East to work on two Naval projects.

In March 2003, "I became violently ill during a night live-fire exercise with the [Navy] SEALS," Manofsky said. "I felt like I was air sick. All the flashing lights from the tracers and rockets ... targeting device made me really sick. I threw up for an hour straight before being medevac'd back to the Special Forces compound where I had my first ever panic attack."

For three years, he had to walk with a cane due to a loss of equilibrium. Numerous other accounts like Manofsky's can be found on the web site lariaminfo.org.

In 2008, Dr. Nevin published a study detailing a high prevalence of mental health contraindications to the safe use of mefloquine in soldiers deployed to Afghanistan. Responding in part to concerns raised by the mefloquine-associated suicide of Army Spc. Juan Torres, internal Army presentations confirmed that the drug had been widely misprescribed to soldiers with contraindications, including to many on antidepressants.

A formal policy memo in February 2009 from Army Surgeon General Eric Schoomaker removed mefloquine as a "first-line" agent, and changed the policy so that mefloquine would not be prescribed to Army personnel unless they had contraindications to the preferred drug, the antibiotic doxycycline. Nor could mefloquine be prescribed to any personnel with a history of traumatic brain injury or mental illness.

By September 2009, the policy was extended throughout the DoD.

New prisoners are no longer arriving at Guantanamo and the prison population has been in decline in recent years as detainees are released or transferred to other countries. Currently, the detainee population at Guantanamo is a reported 174.

But Nevin said the justification the Pentagon offered for using mefloquine to presumptively treat detainees transferred to the prison beginning in 2002 "betrays a profound ignorance of basic principals of tropical medicine and suggests extremely poor, and arguably incompetent, medical oversight that demands further investigation."
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Re: "Pharmacologic Waterboarding" at Guantanamo

Postby professorpan » Thu Dec 02, 2010 3:53 pm

I just stopped by the forum to post this.

I took Lariam before a trip to Costa Rica almost a decade ago, and (as directed) several nights after I arrived. One night, after taking a dose, I had what I can only describe as a lucid nightmare. I was immersed in a barrage of scenes of pure horror, one after another—watching a child get crushed by a car, a man step out from a doorway with a knife in his hand, plunging it into my chest, animals being mutilated, all sorts of gruesome acts of violence—one after another, in rapid succession. I knew I was dreaming, but could not make it stop. It went on and on and on.

It was literally hell. I thought I would go permanently insane.

I woke up, finally, and felt like my soul had been stolen. I was whimpering like a frightened child, terrified that I had lost my mind. It took a long time before I started feeling close to normal, and the rest of the day I was emotionally shell-shocked.

That's Lariam.
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Re: "Pharmacologic Waterboarding" at Guantanamo

Postby surfaceskimmer » Sat Dec 04, 2010 12:40 am

Read Albarelli's "A Terrible Mistake".
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Re: "Pharmacologic Waterboarding" at Guantanamo

Postby American Dream » Thu Mar 03, 2011 4:47 pm

Published on Truthout (http://www.truth-out.org)

KBR's Foreign Contractors at Guantanamo Spared Controversial Anti- Malarial Drug Given to Detainees

Jeffrey Kaye and Jason Leopold | Thursday 03 March 2011



The Defense Department has claimed it took the unprecedented step of forcing all "war on terror" detainees sent to Guantanamo in 2002 to take a high dosage of a controversial anti-malarial drug known to have severe side effects because the government was concerned the disease could be reintroduced into Cuba by detainees arriving from malaria-endemic countries Afghanistan and Pakistan.

But hundreds of contractors who were hired by Kellogg Brown & Root (KBR), at the time a subsidiary of Halliburton, the oil services firm formerly headed by Dick Cheney, from malaria-endemic countries such as the Philippines and India and tasked with building Guantanamo's Camp Delta facility in early 2002 did not receive the same type of medical treatment, calling into question the Pentagon's rationale of mass presumptive treatment of detainees with the drug mefloquine, a Truthout investigation has found.

Numerous peer-reviewed journal articles and public health experts have linked mefloquine, also known by its brand name, Lariam, with severe side effects, including vertigo, nausea, vomiting, dizziness, anxiety, panic attacks, confusion, hallucinations, bizarre dreams, sores and homicidal and suicidal thoughts.

Indeed, a 2002 study reported that upwards of 80 to over 90 percent of all healthy volunteers administered treatment doses of mefloquine suffered either vertigo or nausea. According to the study by Austrian researchers, "Participants suffering from severe (grade 3) vertigo (73 percent) required bed rest and specific medication for 1 to 4 days."

Last December, Truthout published an investigative report that, for the first time, revealed details of a previously secret government policy that called for all detainees sent to Guantanamo to be given 1,250 milligrams - the treatment dosage - of mefloquine, regardless if they had malaria or not.

Defense Department spokeswoman Maj. Tanya Bradsher told Truthout a "decision was made" to "presumptively treat each arriving Guantanamo detainee for malaria to prevent the possibility of having mosquito-borne [sic] spread from an infected individual to uninfected individuals in the Guantanamo population, the guard force, the population at the Naval base or the broader Cuban population."

Capt. Albert Shimkus, who was head of the Naval Hospital at Guantanamo and the chief surgeon for Joint Task Force 160, told Truthout the hundreds of contractors who arrived at Guantanamo in March 2002 to construct prison camps were the medical responsibility of the contracting agency, which was KBR.

Shimkus, who signed the Standard Operating Procedure (SOP) in January 2002 authorizing the 1,250 mg dosage of mefloquine for all Guantanamo detainees, said he was told by KBR personnel, during a meeting around that time at separate medical facilities used by the firm at the naval base, that contractors were taking malaria prophylaxis drugs and would remain on such drugs while they remained on the island.

Shimkus said he could not recall what anti-malarial drugs the contractors were taking, but he believed they were not given treatment doses of mefloquine.

Chemical prophylaxis of malaria is not necessary in areas where the disease is not endemic, except for a few weeks after leaving a malaria-endemic area, according to tropical disease experts.

Gabriela Segura, a spokeswoman for KBR, told Truthout that KBR provided "immunizations against diseases and harmful agents endemic to each employee's destination in accordance with the recommendations of Centers for Disease Control and Prevention, International SOS, and the World Health Organization."

However, Segura said KBR could not identify the anti-malarial drug administered to the corporation's contractors at Guantanamo.

Bradsher, the Defense Department spokeswoman, referred all questions about the treatment of contractors to KBR, stating that the firm is "responsible for its own contractors."

Shimkus said he never reviewed medical records or other documents pertaining to KBR contractors to verify they were being treated with anti-malarial medications, nor did he inquire about the medical status of any of the workers brought to Guantanamo. Instead, he said he relied on assurances from KBR.

"I was confident," Shimkus told Truthout, "that, based on the information we were receiving from [KBR], that the malaria situation was under control, and they understood the environment they were coming into, and they were all using chemical prophylaxis."

Relying on the contracting agency is consistent with a Defense Department document from Naval Facilities Engineering Command (NAVFAC) entitled "Special Conditions for Guantanamo Bay Projects."

The October 2004 document, which was issued while mefloquine treatment was still an active policy at Guantanamo, states that contractors "shall screen prospective employees with the objective to exclude those with admitted chronic disorders from traveling to Guantanamo Bay."

It notes that contracting firms such as KBR shall make "Every reasonable attempt ... to prevent personnel with chronic disorders, which may require treatment, such as cardiovascular defects, tuberculosis, mental health problems, and alcoholism, from being sent to Guantanamo Bay."

While the NAVFAC document puts primary responsibility for the health of contract workers onto the contracting agency, a KBR statement provided to Truthout puts the onus for extraordinary health measures on the Department of Defense.

As described by Segura, KBR's policy notes that it looks "to the client to determine if any added health measures are necessary for employees, contractors or subcontractors." According to their policy, "Any guidance as to additional health procedures will then be incorporated at the direction of the client."

According to a public health expert who previously spoke to Truthout about the questionable practice of administering high doses of mefloquine to detainees, the only anti-malarial drug that would have eliminated the malaria parasite at infectious stages of its life cycle was primaquine. That drug is only administered for two weeks, yet Shimkus indicated that KBR contractors took anti-malarial drugs for the entirety of their stay at Guantanamo, and that more than one drug was used, depending on the worker's country of origin. It's not known if foreign contract workers were given primaquine because Segura said KBR was unable to locate any individuals at the corporation who would be in a position to disclose the drugs the firm gave its contract employees.

Cuban Government Concerns

In a second report Truthout published last December on the use of mefloquine at Guantanamo, Shimkus said one of the reasons the Pentagon took the extraordinary step of implementing a policy of mass presumptive treatment was to address concerns raised by Cuban government officials about the possibility of reintroducing malaria into the country.

The benefits of mass empiric treatment of detainees, although unprecedented, "outweighed the risks," Shimkus said.

An emailed request for comment sent to the Washington, DC office of the Cuban Interests Section, an organization established in 1977 to foster dialogue between US and Cuban diplomats, was not returned.

A Hurried Hiring Process

The hiring of low-wage contractors to work at Guantanamo was fraught with controversy. A report published in Asia Times in July 2006 stated that KBR's hiring process was kept "under wraps by both the US and Philippine governments."

Using a Philippine recruitment agency with ties to KBR, Asia Times reported that the Philippines and the US agreed that "all worker travel documents and recruitment requirements would be expedited in just a few hours by US embassy officials."

"According to people familiar with the situation, the Guantanamo-bound Filipino workers were allegedly slipped out of the Ninoy Aquino International Airport without passing through standard immigration procedures and left Manila onboard a chartered flight to Cuba," Asia Times reported.

That story is backed up by a news report published in August 2002 by Filipino-American journalist Rick Rocamora, who interviewed one of the contract employees from the Philippines. According to Rocamora's account, "the Philippine Overseas Employment Administration [POEA] received a phone call from the US Embassy and the Philippine Ambassador in Washington D.C. to expedite approval."

The approvals, which reportedly can take some months to process, were rushed through within 24 hours and the workers "transported on a chartered DC-10 Greece-registered Electra Airlines direct to the US naval base in Guantanamo Bay with refueling stops in Dubai, Greece, and Portugal."

Segura, the KBR spokeswoman, said, "As a matter of practice, KBR provides medical mobilization physicals prior to employees deploying to international projects."

The speed with which the contract workers were recruited and sent to Guantanamo raises questions as to whether KBR, POEA and its subcontractors had sufficient time to assess the newly hired workers for malaria or other diseases. Neither POEA nor Anglo-European Services, cited in reports by Rocamora and Asia Times as the local recruitment agency for the workers in the Philippines, returned requests for comment.

Both India and the Philippines have higher risk profiles of transmission of the deadly falciparum variant of malaria than does Afghanistan. In India in 2002, there were 1.86 million cases of malaria, over 40 percent from the deadly falciparum strain, and most parts of the country are considered to have high transmission rates of the vivax form of the disease. Almost 1,000 people died of malaria in India in 2002.

In the Philippines, there is a great deal of variability of risk depending on the region of the country, but 57 out of 79 provinces are considered malaria-endemic. Confirmed cases of malaria in the Philippines from 2002 to 2005 went from approximately 38,000 to over 50,000 cases per year.

Lingering Questions

Defense Department officials have claimed US personnel stationed at Guantanamo were not given treatment or prophylactic doses of mefloquine or any other anti-malarial medication because their concerns about the disease rested solely on its reintroduction into Cuba by foreign nationals and not on malaria of Cuban origin.

However, the Defense Department's reasoning for developing a policy of mass presumptive treatment for detainees, and detainees only, using the drug mefloquine raises questions about other possibilities as to why the drug was administered.

A report by Seton Hall University School of Law's Center for Policy and Research last December, issued at the same time Truthout released the findings of our investigation, stated that treatment doses of mefloquine on all the detainees, without an accepted medical rationale by any public health official willing to publicly support the policy, could be attributed to a medical experiment, "gross medical malpractice" or possibly one of three other possibilities, any of which "would likely satisfy the legal definition of torture as articulated by the Department of Justice in 2002."

Shimkus has vehemently denied that mefloquine was used for any other purpose. He said the policy of mass presumptive treatment was enacted following discussions he and other military officials had with the Centers for Disease Control (CDC), the Navy Environmental Health Center (NEHC) and the Armed Forces Medical Intelligence Center (AFMIC) at Fort Detrick, Maryland, which is part of the Defense Intelligence Agency (DIA). The human intelligence division of DIA was one of the primary agencies involved in the interrogations of the detainees.

Shimkus said he also answered to a medical chain of command that ran through the United States Southern Command (SOUTHCOM), indicating that senior Pentagon officials would have been knowledgeable about the policy. He said he could not recall the name of the official to whom he reported.

CDC has refused repeated requests for comment. A spokesperson for the Navy and Marine Corps Public Health Center (formerly NEHC) indicated no response was available for publication at press time. Truthout's request for comment was being "coordinated through the Navy's Bureau of Medicine and Surgery and may require additional coordination and permission through the Chief of Naval Information offices in Washington, DC."

A defense official who spoke to Truthout on background said the role of AFMIC, now known as the National Center for Medical Intelligence (NCMI), is to provide "infectious disease risk assessments in support of US military and civilian force protection measures. NCMI's function does not include prescribing treatment or making treatment policies."

The defense official also noted the importance of using anti-malaria drugs "where malaria risks are heightened." However, he would not directly comment on what AFMIC told Guantanamo officials in 2002.




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