There’s no way to undo what survivors of torture have suffered, but we can help them to get on with their lives,” Allen Keller, M.D., told me during an interview in his office at New York City’s Bellevue Hospital, the oldest public hospital in the nation. Dr. Keller is director of the Bellevue/N.Y.U. Program for Survivors of Torture, co-sponsored by Bellevue and the adjoining New York University School of Medicine. More than 2,000 people from around the world have received treatment there.
Survivors’ stories can be horrific. Keller tells of a Tibetan artist who was forced by Chinese interrogators to put his hands into an oven as punishment for having criticized the government. Eventually, he managed to flee to India, and then to the survivors program in New York. “He could barely hold a pen when he arrived,” says Dr. Keller, who treated him. But after pain management and reconstructive surgery, together with individual and group therapy, the artist is now drawing again and writing poetry. In describing the long road back to recovery, Dr. Keller stresses the interdependency of various aspects of the program—physical, psychological and social. But even with extensive medical intervention on all three levels, “suffering often continues in the form of nightmares and flashbacks,” he says. After the terrorist attacks of Sept. 11, 2001, he notes, “a lot of patients in our program had disturbing retraumatizing memories.”
The survivors program had its roots in Dr. Keller’s experiences as a medical student. Taking a year off from his studies in the mid-1980s, he traveled to southeast Asia to work as a volunteer in refugee camps on the Thai-Cambodian border. That work, says Keller, “opened my eyes to the interrelationship between health and human rights.” Volunteering within a large refugee population, he “realized that they were not there because of natural disasters, but because of the widespread human rights abuses that come from war. It was my first time,” he observes, “to hear stories of trauma, torture and death by starvation.”
On his return to New York, Keller joined Physicians for Human Rights, a network of health professionals who, among other activities, volunteer to examine individuals who claim to have been tortured and are applying for political asylum in the United States. Members help to prepare affidavits on their behalf. Dr. Keller sat in on a session with a torture survivor and subsequently began to do evaluations himself. On completing his residency, he returned to southeast Asia to spend the year 1992-93 in Cambodia. There, he says, “I was doing public health work but also helping train Cambodian health professionals how to document human rights abuses.” The abuses were many. “Every Cambodian I met there had lost one or more family members during the rule of the Khmer Rouge, both then and in the succeeding years.”
The Program for Survivors of Torture
Back in New York and joined by colleagues, he set up the Program for Survivors of Torture in 1995. The program has established an international reputation. The issue of torture has become more pressing after the 9/11 terrorist attacks, and since then with allegations that U.S. interrogators of terrorism suspects have crossed the line into practices that some saw as torture.
Dr. Keller began to testify before Congress as an expert in the evaluation of torture victims. In testimony in September 2007 as a member of the program’s advisory council, he spoke of the now highly publicized form of torture by water immersion. One of his patients, who had been repeatedly submerged in a vat of water while being interrogated, told him that even years later, he “still felt as if he was gasping for air whenever he went out in the rain.” Another patient of his “had a gun pointed at his head which would be abruptly pulled away and then fired into the air.” The patient told him, “even now I still hear the sound of the gunshot in my head—this torture is encrusted in my brain.”
Dr. Keller emphasizes that the various forms of torture rarely occur in isolation. Rather, a person placed in prolonged isolation in a dark cell might also be exposed to intense heat or cold and to loud noises. When combined, the physical and psychological impact is compounded. The psychological impact can be the more damaging, Keller says. “One individual I cared for spoke of the dread of waiting to be called in for an interrogation and hearing the screams of a colleague or loved one being tortured.”
Other common forms of torture include sleep deprivation, forced standing, sexual assaults and beatings. The term water boarding—made infamous by Michael Mukasey’s equivocal answers about the interrogation method during his confirmation hearings as candidate for attorney general—is symptomatic of the misleading terms for coercive questioning the C.I.A. has used. Such terms are intended to de-emphasize the agonizing nature of what actually takes place. “And we use other ridiculous terms like ‘enhanced interrogation techniques’ that have now come into the C.I.A.’s lexicon,” Dr. Keller says. The same is true of the term “extraordinary rendition,” he adds. “Let’s call it what it is: arresting individuals and sending them to secret overseas locations where they’ll be tortured, because we think that sending them to another country that allows it to happen somehow distances the torture from us.” By sending the prisoners, though, we ourselves are just as culpable, Keller says. But by whatever sanitized names they are known, he says, “all torture methods have dangerous health consequences. They make the world a much more dangerous place; using them is like pouring kerosene on a fire.”
Expert Testimony and Retaliation
That metaphor took on special relevance a few days later, when I attended a daylong conference Dr. Keller co-organized at the New York University School of Medicine. One of the speakers, Sheri Eppel, a clinical psychologist, is from Zimbabwe, where torture has been common for decades, first under white rule when the country was known as Rhodesia, and in recent years under Robert Mugabe. (Dr. Keller himself visited Zimbabwe last summer to investigate its use of torture.) Ms. Eppel, who has treated torture survivors, described how the U.S. involvement in torture at the notorious Abu Ghraib prison in Iraq has led to a sense in countries like hers that “since the Americans torture, we can too.” In other words, the bad example set at Abu Ghraib and by U.S. interrogators at Guantánamo has indirectly lent support to the use of methods banned by the U.N. Convention Against Torture. Ms. Eppel said that she has received death threats because of her research on the massacre of 20,000 people under President Mugabe in the 1980s.
Similarly Alp Ayan, M.D., another speaker at the conference, spoke of retaliatory measures the government of Turkey has taken against him and his associates because of their advocacy work there. Dr. Ayan, a psychiatrist, is a co-founder of the Human Rights Federation of Turkey and has defended many prisoners who have been abused while incarcerated. He said that in retaliation for his challenging such abuse, the government had brought 60 cases against him in half a dozen years, charging him with such fabricated offenses as “humiliating the justice system and the military.” Although some of the charges have been dismissed, Dr. Ayan said that he currently faces three years in prison. That sentence is being appealed, and he may never have to serve it, but it shows the dangers confronting those who by denouncing torture bring an unwanted spotlight on governments that allow it.
Medical Collaborators
In his lecture, Dr. Ayan noted a situation about which Dr. Keller too has expressed concern: the collaboration of some medical doctors with “enhanced interrogation techniques.” Such collaboration can extend to doctors’ issuing false medical reports to conceal the fact that torture occurred. In Turkey, Dr. Ayan and other members of the federation they founded persevered in interviewing prisoners, to the point of “measuring scars” to prove that physical abuse had occurred within the walls of detention facilities. Such proof intensified the government’s efforts to retaliate against him and his organization. He points out that torture is not an individual act, but one that involves all who play even an indirect role. Indirect participation can include the deliberate withholding of medical care from prisoners with life-threatening illnesses. He described a man sent to prison with early-stage cancer and chained to his bed. Because doctors in his detention center chose not to treat him, the disease progressed so far that it became irreversible.
For his part, Dr. Keller spoke before the Senate’s intelligence committee regarding doctors who violate the spirit of the Hippocratic oath: “A dual role as health professional-interrogator undermines the health professional’s role as healer...and using medical information from any source for interrogation purposes is unethical.” At the same hearing, he flatly denied claims that “enhanced” interrogation techniques like those used by the C.I.A. were safe because of medical supervision. As for the negative impact of torture on the image of the United States abroad, Keller said that it “undermines the moral core of who we are as a society.... I’m saddened that we now have to rebuild our credibility, not least in the wake of a president who has claimed that the United States does not torture.”
“Such a claim is nonsense,” Dr. Keller told me, citing the U.S. Army’s field manual as a useful guide for establishing a minimum standard, with its refusal to condone torture or to use abusive interrogation methods on captured militants.
Even torturers themselves sometimes awaken to the realization of what they have done, he pointed out. “They may be haunted by nightmares, shame and terrifying memories, ironically mimicking the same reactions they had induced in those they tortured. In the long run, they often pay a terrible price.”
Defining Torture
The Program for Survivors of Torture, Dr. Keller observes, follows the United Nations’ definition of torture, which he paraphrased as severe physical or mental suffering inflicted for a variety of reasons, be it to intimidate or to collect information, done by individuals acting in an official capacity. The New York survivors program also treats people whose abusive treatment “does not meet that classic definition.” As an example, he referred to wartime events in the former Yugoslavia: “We saw a lot of people from Kosovo whose homes were set on fire by Serbian troops; they were not tortured in the more usual sense of the word, but they were profoundly traumatized.” He mentioned a situation in an Eastern European country that involved what he referred to as “deliberately induced refugee trauma” when, in the presence of her parents, paramilitary forces poured scalding water over a girl’s head.
Few victims of torture and trauma are fortunate enough to reach the survivors program in New York or others elsewhere. “What we see here,” Dr. Keller says, “is only a discrete sample—individuals who had the wherewithal to get out of their countries and the resources to make it to our program for help.” Here, he continues, “we try to restore their dignity and a sense of trust and safety.” But he warns that the lengthy healing process can mean one step forward and two steps back. Dr. Keller emphasizes that most torture victims around the world are not terrorist suspects. “Torture is more commonly used to intimidate and harass, not only individuals but entire communities,” he explains. “When the Chinese authorities torture a Tibetan monk for chanting ‘Long live the Dalai Lama,’ or when a despotic government like Zimbabwe’s tortures a student human rights advocate, they’re doing it not so much to get information as to send a message to others: if you dare to speak out, this is what will happen to you.” What torture does effectively, he concludes, is to undermine “a sense of who we are as a society and the core values we hold dear in the United States; that’s why by trying to eradicate it, we make the world a more humane place.”
Has torture increased over the past decades or has focused reporting heightened public awareness of the issue? In Dr. Keller’s opinion both are true. He says, “There are more resources to document torture, which is known to occur in over 90 countries.” Much of the debate in the United States over its use revolves around an argument that in these dangerous times abusive interrogation techniques may be justified. “But that argument is dubious at best,” Keller says, “it’s not accurate to say that such methods elicit useful information.” He noted that individuals under torture “will say anything to stop the pain.”
Early in my visit with Dr. Keller, he answered a question from someone passing by in the hallway. I had a chance to glance around the room. It was mid-afternoon, and his uneaten lunch still lay on the table behind his desk. On the wall hung a plaque, the 2003 Humanism in Medicine award. I heard him say to the person at the door, “I’m one of those people who’s swamped.” Swamped, an observer could say, by dedication to helping victims of torture resume their lives and to pressing the U.S. government to stop its direct and indirect use of torture.
