At a Glance
Both sides are briefing the Trump administration's efforts to reverse a court order for a panel of medical experts to evaluate Al Qahtani's mental health.
Mohammed al Qahtani
Mohammed al Qahtani was sent to Guantánamo in February 2002. Within months of his arrival, Mr. al Qahtani was subjected to a systematic and brutal program of physical, sexual, and psychological torture. Officials in Washington, up to and including then-Secretary of Defense Donald Rumsfeld, helped design and approve the plan, with the active participation of psychiatrists. He was hospitalized twice during his interrogation at Guantánamo because he was on the brink of heart failure and death. Al Qahtani remains the only detainee whose abuse a senior U.S. government official has admitted was “torture.”
His torture became widely known only because records describing the execution of the torture plan were leaked to Time magazine in 2005. The torture plan was designed to “break” Qahtani, to “drive him crazy,” and it is easy to read those initial stories and assume they show a sane person driven slowly into madness. But as early as his first year at Guantánamo, in 2002, the FBI observed him “talking to non-existent people, reporting hearing voices” and “crouching in a corner of the cell covered with a sheet for hours on end” before the implementation of the torture plan on him by military interrogators and psychiatrists. As the government was well aware even before they began torturing him, Mr. al Qahtani was already severely mentally ill long before he arrived at Guantánamo. Indeed, he was suffering from psychosis long before the time the U.S. government accused him of having associated with criminals or traveling to Afghanistan.
Al Qahtani’s problems began when he was in a car accident at age eight: he was thrown from the car and suffered a traumatic brain injury, after which his performance in school, which had been excellent, suddenly collapsed. In late adolescence, the classic age for onset of schizophrenia, his family witnessed uncontrolled crying and inability to deal with basic life functions. At one point the Riyadh police pulled him naked from a garbage dumpster he had thrown himself into. Later, in Mecca in May 2000, he was arrested by police after throwing himself half-naked into traffic and was involuntarily confined to a psychiatric hospital where he was diagnosed with schizophrenia.
The government does not contest these facts, which are documented in the reports of Dr. Emily Keram, the only independent psychiatrist known to have examined Mr. al Qahtani since his imprisonment, and in records of his hospitalization in 2000. Dr. Keram was appointed by the district court to conduct a psychiatric evaluation of Mr. al Qahtani, and after a series of visits beginning in 2015 confirmed his diagnosis of schizophrenia and major depression, now combined with post-traumatic stress disorder (PTSD) caused by his torture and abuse in confinement. After Dr. Keram’s report became public in 2016, the military finally acknowledged that al Qahtani’s symptoms, as observed by the guard force and Joint Medical Group mental health professionals, are consistent with schizophrenia and has begun efforts to dispense antipsychotic medications to him, including Aripiprazole (Abilify), Quetiapine, and Haldol.
Schizophrenia is a chronic disorder. It is permanent; it may be eventually manageable, but it is not curable. As Dr. Keram put it, “[the g]oals of appropriate treatment are symptom management, not cure.” The systematic torture al Qahtani survived at Guantánamo—which included prolonged solitary confinement, sleep deprivation, physical violence and grotesque sexual humiliation along with other forms of psychological torture—have caused him to suffer from Post-Traumatic Stress Disorder (PTSD). But that abuse also left him unable to trust American military doctors; one of the psychiatrists who helped design his torture program has been publicly reported as having been in the room during his interrogations under torture. Although PTSD—unlike psychosis—is often curable, Dr. Keram believes that Mr. al Qahtani needs to be treated by Saudi doctors who understand his culture and speak Arabic, and that any recovery from PTSD cannot take place at Guantánamo, where he was tortured. Dr. Keram also believes that successful treatment requires the involvement of Mr. al Qahtani’s family as well. All these factors argue strongly for his repatriation to psychiatric care in Saudi Arabia.
The current legal regime applied by the federal courts holds the detainees as if they were prisoners of war in a never-ending “war against terrorism.” But the Geneva Conventions never contemplated prisoners remaining in custody into their old age or while suffering from incurable mental illness. Instead, they mandate that a panel of medical experts decide whether prisoners are so infirm that they are unable to take part in armed conflict, in which case the rationale for their detention has evaporated and they must be sent home. In the middle of World War II, the United States sent home over a thousand German soldiers under a similar set of procedures—mostly young men, with combat wounds, tuberculosis, or PTSD from shellshock. In 2017, al Qahtani filed a motion demanding that the government convene just such a panel, a “Mixed Medical Commission” of three medical experts, as provided for under current U.S. military regulations. After a very long delay precipitated by the judge’s illness, the judge ordered the government to convene an Mixed Medical Commission for these purposes. The government appealed, and al Qahtani filed a motion to dismiss that appeal as premature. Meanwhile, the government sought a stay of the order pending appeal, which the district court denied on August 12, 2020. The Court of Appeals granted our motion to dismiss the appeal on September 29, 2020. The government did not appeal. However, five days before the end of the Trump administration, Secretary of the Army Ryan D. McCarthy issued a memorandum claiming that the Army Regulation allowing for this neutral medical examination does not apply to anyone at Guantánamo, and then moved to vacate the district court's order.
Like many mentally ill people, for most of his life Mr. al Qahtani was in denial about his illness. He (like his family) understood it not in psychiatric terms as a permanent illness but as a form of possession, for which the likely cure was religious ministration and prayer. Both he and his family now fully accept that he has a psychiatric illness and needs medical treatment for it—in all likelihood, in psychiatric confinement—back home in Saudi Arabia.