Autopsy Report: Fawaz Badaa Najem, Abu Ghraib Prison, Iraq (Undetermined) (Death Certificate Included) (0016-04-CID789-83992)

Autopy no: ME04-434; Fawaz Badaa Najem, a 42 year old male Iraqi civilian, was in US custody at Abu Ghraib. Be began making gasping sounds which awoke another detainee. The decedent was found to be unresponsive and pulseless. Resuscitation efforts were unsuccessful. Cause of death: Undetermined. Manner of death: Undetermined. No evidence of significant trauma to explain the death, although there was minor bruising of the abdomen and left arm.

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Monday, June 14, 2004
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Sunday, April 17, 2005
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0061-04-CID789-83992
eFor Official Use Only I Law Entorcemefllensitive
PRISONER IN· PROCESSING MEDICAL SCREEN
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NAME: COMPOUND: ISN:
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DATE: ~ +y Cf. 0 --I DOB: I () L '2-/ . AGE: «1-
HISTORY BY TRANSLATOR: YD 1'-10 1 CI NAME OF TRANSLATOR: rb)(6~2 . I
I) DO YOU HAVE ANY NEW MEDICAL PROBLEMS OR INJURIES NOW?
2) HA VE YOU HAD TUBERCULOSIS? IF YES, WliEN AND How WERE YOU TREATED?
A) HA VI:: YOU HAD ACOUOH FOR MORE THAN 2 WEEKS?
YES~
.. · ..
B) HAVE YoU BEEN COUGHING UP BLOOD? YES
C) HAVE YOU BEEN LOSING WEIGHT? YES

3) CHRONIC MEDICAL PROBLEMS (DIABETES, HYPERTENSION, HEART DISEASE):
4) MEDICATIONS:
5) ARE YOU ABLE TO WALK UNASSISTED? ~ NO 6) ARE YOU ABLE TO FEED YOURSELF?
~NO
7) ALLERGIES? .J?J
8)PULSE: bb . BLOOD PRESSURE: 1/0)/7': RESPIRATORY RATE: {C:
WEIGHT: J S'1 HEIGHT: jtf::,"

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SIGNATURE:
A YES TO QUE TlooS 1=4 REQUIRES REFERRAL TO MD OR PA, UNLESS MINOR PROBLEM FOR QUESTION I. A NO TO QUESTION 6OR 7 ALSO REQUIRES MO/PA EVALUATION.
MD/pA FOLLOW UP NOTE DATE:
ASSESMENT:
RECCOMENOATIONS:
SIGNATURE:
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IDENTIFICATION 01 O"AVE
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HEALTH RECORD C.HRONOLOGICAL RECORD OF MEQICAi.. CAR~

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0061 ~04-CID789-83992
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ARMED FORCES INS1'ITUTE OF PATIIOLoGY
Office ofthe Armed Forees Medical Exaininer
1413 Research Blvd.~ Bldg. 102
Rockville; MD 20850
1-800-944-7912

FINAL AUTOPSY REPORT
N~~rs~ I Autopsy No.: ME04-434 Nati~nalDetainee Reporting SystemfSJ-4 AFIP No.: 2931951 Date of Birth: 1 January 1962 "-------' Rank.: Iraqi civilian Date ofDeath: 14 JUIle 2004 Place ofDeath: Abu Ghraib, Iraq Date ofAutopsy: 19 June 2004 Place ofAutopsy: Baghdad. Iraq Date ofReport: 13 October 2004
Circl,lmstanees ofDeath: This 42 year-old male Iraqi civilian was in US custody at the Ba~hdad Central Confinement Facility in Abu Ghruyeb, Iraq. By report, he began making gasping soundst which awoke another detainee. The decedent was found to be unresponsive and pulselesS. and resuscitation efforts were unsuccessful.
Authorization for Autopsy: The Armed Forces Medical Examiner, IAW 10 USC 1471.
Identification: Visual and documentation accompanying the body; fingerprints and DNA sample obtained
CAUSE OF DEATH: Undetermined MANNER OF DEATH: Undetermined
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FINAL AUTOPSY DIAGNOSES:

I. No evidence ofany defuritive significant trauma
a. Minor contusions ofabdomen and,le!\ ann
II. Cardiovascular Findings (AFIP Cardiovascular Pathology consultation)
a. Mild coronary atheroscler.qsis '
1. 40% luminal narrowmg ofproximal left anterior descending
coronary artery
ii. 20% luminal narrowing ofproximal left circumflex coronary artery
iii. 30% luminal narrowing ofptoximai right coronary artery by
iIitiInal thickening
b, Moderate dysplasia ofatrioventricular nodal artery
i. No increased fibrosis ofseptum '
III. Additional Findings: probable artifacts ofresuscitation or freezing ofbody
a. Filtn ofperitoneal blood orupper abdomen, SO ml
b. Hepatic findings
i. Subcapsular accumulation ofblood over right lobe ofliver; capsule
grossly intact ,
lL. Parenchymal clefts and focal disruption of right lobe ofliver
1. Histologically, no inflammatory response, fibrin or clot
formation, olother evidence ofany vital reaction
IV. Medical Intervention
a. Endotracheal tube in place
b. ' Intravenous catheter io left antecubital fossa
c. One adhesive EKG tab on abdomen

V. Early to moderate decomposition
a.
Marbling of torso, arms an(liegs

b.
Mark~facial and scalp congestion and dark discoloration c.. Corneal opacification

VI. Toxicology (AFIP)
a.
Volatiles: Heart blood and urine negative for ethanol

b.
Cyanide: Heart blood negative

c.
Drugs: Heart blood negative for screened medications and drugs ofabuse

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AUTOPSY REPORT ME04-434 3 t)(SH I
EXTERNAL EXAMINATION
The body i$ that ofawell developed, well-nourished male clad in a pair ofyellow "Reebok"
shorts, a pair ofgrey drawstrli!g P••and a previously cut, white t-shirt The body weishs
approximately 150 pounds; is 67" in height and appeBl'l! cQmpatible with the t~rtedage of
42~, The body is cold, the temperature that ofth.e refrigeration unit. Rigor is waning.
Lividity is pre8mlt;m.d ijxed on the posterior surface ofthe body, except in areas exposedto
pressure, ~over the lace and head.

Early to moderate dCCOmpositonal changes are present, consisting ofdiffuse marbling of the .
back., upper arms and legs; early marbling ofthe sides ofthe abdomen; partial corneal
opacification; and dark discoloration and congestion ofthe face, scalp and neck.

The Scalp is cov~withblack rum-with frontal and parietal.alopecia bilt 9therwise in a
nonnal distri1;nition, averaging 3 em in length. Facial hair consists of a dark mustache and
full beard. The irides appear dark, but are partially obscured by comealclouding. 1'he
sclerae and cotYUn,ctivae are congested. especially ofthe left eye, but there are no petechiae.
The earlobes are not pierced. The external auditory canals, external nares and oral cavity are
free offoreign material and abnormal secretions. The nasal skeleton is palpably intact The
lips are without evident mjury. The teeth are natural and in good condition.

Examinl¢ion of the neck reveals the tracheato be midline and mobile. The chest is
Syminetric anq well developed. Nojnjuryofthe ribs or sternum is evident externally. The
abdomen is slightly protuberant and soft. There is a 2 x 1 cm dark macule on the mid right
side ofthe back.

The eXtremities ar¢ well developed With nonna! range ofmotion. There is a 2 x 1 cm
hYperpigmented patph on the back ofthe right wriSt. There are thick calluses on lateral
aspect oftbe right imkle and on the soles ofthe feet, which are also dirt stained, The
fingern3.ils are short and intact No tattoo$ are noted. The external genitalia are those of a
nonna! adult circUItlcised maie. The testes are descended and free ofmasses. Pubic hair is
partially·shaved but present in a n011l18.l clistnbution. The buttocks and anus ~
unremarkable.

There is an identification band with the name and photograpl1 ofthe decedent around the left
wrist, and there is an identification tag with the name ofthe decedent and date ofdeath on
the tir$t toe ofth~left Coo•• There are creases around the lateral aspects ofthe ankles
consistent with postmortem securing ofthe body.

EVIDENCE OF THERAPY
There is an ~ndotrachea1 tube in place secured with white tape aroWld the head, and there is
an adhesive :aKG tab on the lower right side ofthe abdomen. There is a needle ptincture
mark with surrounding ecchyinosis in the right antecubital fossa, and there is an intravenous.
catheter secured with white tape in the left antecubital fossa. -1

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A 'ITOPSY REPORT ME04-434 4
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EVIDENCE OF IN.JlJRY
There is a 2 x 0.3 em red contusion~ust above the umbilicus. a,pd there is a 3.5 x 2.5 em red contusion ofthe lower right aspect Qfthe abdomen. On the anterior (palmar) aspect of the left lower foreann and wrist, theJ:'e is a 4 x 3 em red brown contusion. and there is a 3 x 2cm. contusion ofthe left thenar region.
On external examination ofthe body, there is no other evidence oftrauma.
INTERNAL EXAMINATION
BODY CAVITIES: the body is opened by the usualthoraco-abdominal incision, and the chest plate is removed. No adhesions or abnotIllBl coIlC:ctions of fluid ate present iii the pleural or pericardial cavities. There is il fihn of blood in the upper peritoneal cavity, less than'50 mI. No adhesions or ~nonnaJ: collections of fluid are presellt in the peritoneal cavity; All body organs are present in the normal anatomical position. The subcutaneous fat layer of the abd.o~ Wall is 2 em thick. Thete is no intemal evidence of blunt force otpenetrating injury to the thoraco-abdom.inal region.,
HEAD: (CENTRAL NER.VOUS SYSTEM)The scalp is reflected, and there is Il18lXed ~ga1~ congl;Stion an~ fix:ed lividity. but no subgaleal hemorrhage or skull frac~found, The calvarium ofthe skull is removed. The dura mater arid f~cerebri are intact, There is no epidural or subdural hemorrhage present. The leptomC$iilges are thin and, delicate. The cerebrospinal fluid is darIc with deeornpositi.()nat change, lllOst prominent over the occiplit; however, there is no evidence of any subailwhrioid hemorrhage. The cerebral hemispheres are symmetrical. Thl' stiucfures at the base oftbe blain, including craniai ner'VC$ and blood veSsels, are intact. Coronal sections through the cerebral hemispheres revealed, no lesioIlS; and there is no evidence of infection. tumor, or trauma. TranSverse .sections .tbrougll the brain stem and. cerebellum are unreinarkabl~. the dura is stripped from the basilar skull, and no fractureS are found. The atlanto-occipital joint is stable. The brain weighs 1455 grams.
NECK;
Exainination of the soft tissues of the neck, including strap muscles, thyroid gland and large
vesseis, revealS no abnormalities. The IIIltenor strap muscles of the neck are homogeneous
and red-brown. without hemorrhage. The thyroid cartilage and. hyoid bone are intact. The
larynx is lined by intact white mucosa and is unobsfructed. The thyroid gland is symmetric
and red-broWil, without cystic ot nodular change. There is no evidence of infectioli, tumor.
or trauma. and the ait;Way is patent Incision and dissection of the posterior neck
dernonstnttes no deep paracervical m,uscular injury, hemorrhage, or fractures ofthe dorsal
spinous processes.
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A.IITOPSV REPORT ME04-434 5
[")(6)4 I
CARDIOVASCVi..AR SYSTEM; See ''Cardiovascular P;!thology Report" below~ The pericardi~ surfaces are sn:i.oo~ glistening and unremarkable; the pericardia! sac is free ofsignificant fluid and adhesions. A moderate amount ofepicardial fat is present. The coronary arterieS arise normally in a right domimmt pattern and follow the usual distribution. There is mild atherosclerosis with focal areas of luminal stenosis of the coronary arteries. wi.thoui evidence of thrombosis. The myocai"di~ ~ dark red~brown, firm and unrein~able; the litrial and ventricular septa are . i.p.tapt~ The left ventri~le is 1.5 cm in thickness and the right ventricle is 0.4 cm In thickness. The aorta and its majorbrailches arise non'nally; foUow the usual courSe and are widely patent, free of significant atheroscletosis and other abnonnality. the venae cavae and their major tributariesretum to the heart in the usual distribution and are free of thrombi. The heart weighs 435 grams.
RESPIRATORY SYSTEM: The upper may is clem; of debris and foreign material; the mucosal surfaces are smoo~ yellow-ian and' unremarkable. . The pleural surfaces are smooth, glistening and unrem.ble bilaterally. The pulmonaryparencbyma is red-purple and edematous. exuding a moderate amount of bloody fluid; no focal lesions are noted. The pulmonary arteries are normally developed, patent and without thromblis or embolUS. The right lung weighs 60S gratns; the left 480 gramS,
LIVER & BalARY SYSTEM: .. The hepatic capsule is smooth, glistening and intact. covering dark red-brown. moderately congested parenchyma, There is focal accumulation of subcapsulaJ:' blood anc:i underlying parencbymal disruption; m.th clefb and splitting' of the parenchyma witho~t associated hemorrhage, consistent with reSuscitatiort or postmortero changes. The gallbladder contains 5 ml of green-brown. mUCQid bile; the mucosa is velvety and unremarkable. The extrahepatic bililllY tree is patent, without evidence ofcaleuli. The liver weighs 1940 grams.
ALIMENTARY TRACT:
The tongue exhibits no evidence of recent injury, The esophagus is lined by gray-white,
smooth mucosa. The gastric mucosa is arranged in the usual rugal folds and' the lumeIJ.
contains a filtn. of dark fluid. The small and large bowel are unremarkable. The pancreas
has a nOl'D;lal p~-tanlobulated appearance and the ducts are cleat. The appendix is present
and is unremarkable.

GENITOURINARY SYSTEM:
The renal capsules are smooth and thin, semi-transparent and strip with ease from the
underlying smooth, red-brown cortical surfaces. The cortices are sharply delineated from
the medullary pyramids. which are red-purple to tan and unremarkable. There is a single
dark .ca~culu$ in the right renal pelvis. The calyces, pelves and ureterS are otherwise
unremarkable:. White bladder mucosa overlies an intact bladder wall. The urinary bladder
contains iO ml. of cloudy, yellow urine. The prostate gland is symmetrical with lobular,
yellow-tan parenchyma and no nodules or masses. The seminal vesicles are unremarkable.
The testes are free of mass lesions, contusions. or other abnormalities. The right kidney'"
weIghs 210 grams; the left 220 grams.

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AUTOPSY REPORT ME04-43. 6
F"6)-4 I .
RETICULOENDOTHELIAL SYSTEM:
The spleen bas a sm90~ intac~ capSl11e covering ted-Plll'P1e, moderately fInn parenchyma;
the lymphoid follicles aJeunreDlarkable. The regional lymph nodes appear normal. The
spleen weighs 260 grams.

ENDOCRINE SYSTEM:
The pituitary, thyroid and adrenal glands are unremarkable.
MUScuLOSKELETAL SYSTEM:
Muscle develoj)1nent is notmal. No bone orjoint abnonnalities are noted.
MICROSCOPIC EXAMINATION
HEART: See "Cardiovascular Pathology Report" below.
BRAIN: See "Neuropathology Report" below.
LUNGS: The alveolar spaces and Smail air passages are expanded and contain no significant inf'iamrnm;ory component or edema fluid. The atveolar walls are thin and mildly congested. The arterial and venous vascular systems are normal. The peribronchial lymphatics are unremarkable.
UVER: . There are numerous clefts and splits of the parenchyma, focally with lakes of fed i)IQodcells. However, there is no inflammatory response or evidence of' org~ation ofthe hemorrhage, with no fibrin or dot fOrn:latlon. The hepatic architecture is otherwise intact. The portai areas show no increased intlanimatory component· or fibrous tissue . .The hepatic parenchymal cells are well~preServed with mild focal steatosis but no
evidence ofcholestasis, or sinusoidal abnormalities.
SPLEEN: The capsule and white pulp are unremarkable. There is moderate congestion of the red pulp.
ADRENALS: The cortical zones are distinctive and well supplied with lipoid. The medullae are not remarkable.
KIDNEYs: The subcapsular zones are unremarkable. The glomeruli are mildly congested without cellular proliferation, mesangial prominence, or sclerosis. The tubules are well preserved. . There is no interstitial fibrosis or significant inflammation. There is no thickening of the walls of the arterioles or small arterial channels. The transitional epithelium ofthe collecting system is nonnal.
tESTES; Unremarkable
THYROID GLAND: Unremarkable
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AUTOPSY REPORT ME04-434 7
br)(6)4 I
CARDIOVASCULAR PAmOLOGY REPORT
Department ofCardiovascular Pathology, AFIP:
"AFIP DIAGNOSIS: ME04-434
1. Moderate dysplasia of atrioventricular nodal artery
2; MUd eoroniary artery atheroscier()sts

History: 42 year old mal: Itaqi detainee, 67", 150 lbs, death in custody'
Heart: 435 grams (prediCted norinaI value 322 grams; upper limit 425 granIs for a l50 lbs
male); nonnal epicardial fat~ closed foramen ova1e~ left ventricular hypertrophy: left
ventricular cav~tydiameter 35 mm, ieft ventricul~ free wall thickness 15 nu:ll, ventricular
septum thickness 15 mzIi; n~tventricle tbickrless 4nun, without woss scars (jr abnormal
fat iilfilttates; grossly unremarIcable valves and enciocardiuni; enlarged membranous
septum; no gross :myocardial fibrosis or necrosis; histologic sections show mild left
ventricular myocyte hyPertrophy, otllerWise unremarkable
Coronary arteries: Normal ostia; right dominance; mild atherosclerosis: 40% luminal
narroWing ofproximalle:ft anterior descending, 20010 narrowing ofproximal left
circumflex, and 30% narrowing ofproximal right cOronary artery by pathologic intimal
thickening ..
Conduction SYstem: The sinoatrial node is unremarkable. The sinus nodal artery shows
miriimaIiy increased proteoglycan. The atrioventricular (,AV) nodal artery showS
moderate dyspl8$ia in: its posterior approaches to the compact A V nOde and in its
pene~tin~bnmches·in the ventricular septum,.but fibrosis is not significantly mcreased
in the septUm. The 'penetrating bundle is centrally located between the nOcle and
venqlcular $eptum. The right proximal bundle branch is uIiremarkable. The left proximal
bundle is not seen in these seCtions.
Comment: We do not see an obvious cardiac cause ofdeath. Moderate dysplasia, of the
atrioventricwar nodal artery is often associated with increased fibrosis in the crest ofthe
ventricular septum, representing a potential substrate for cardiac arrhythmia.. However,
increased fibrosis is not seen inthis case. We cannot exclude the possibility ofcardiac
arrhythmia related to various ion channelopathies Or coronary vasospasm:'
NEUROPATHOLOGY REPORT
Department ofNeuropathology and OphthalmiC Pathology, AFIP:
"We reviewed multiple small fragments ofdura, cerebrum, brainstem and cerebellum
submitted in formalin in reference to this case. No gross abnon:ilalities are present.
Representative sections were processed in paraffin and sections stained with H&E, and
iminllDohistochemical metl,tod$ for beta amyloid precursor protein (BAPP), and glial
fibrillary acidic protein (GF AP). This material was reviewed in' conference by the staff of
,Neuropathology. Sections show few neurons w~thin the cerebral cortex V(ith shrUnken or -1 . vacuolated cytoplasm and hyperchromatic nuclei,. findings interpreted as non-specific
acute neuronal injury. Stains for BAPP and GFAP are negative."
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r)(6H I
. ADDITIONAL PROCEDURES'
-DoCumentary photographs are taken by OAFME photographers -SpeCimens retained for toxicoiogic testing andlor DNA identification are: vitreous
fluid, heart blood, urine, and bile -The dissected organs are foxwarded with the body -Personal effecf$ are released to the appropriate mortuary operations representative
OPINION
Based on available investigation and complete autopsy examination, no definitive cause ofdeath for this 42 year-old male Iraqi civililll1 in US custody in Iraq could be deterxnn.ed. There is no evidence of any signifiCaJlt trauma to explain the death. There is a film ofblood in the upper abdomen, and a small accumulation ofsubcapsular blood over the right lobe ofthe liver with associated subcapsular parenchymal disruption. However. the minimal amount ofhemorrhage; lack orcapsular laceration, and inicroscopic lack ofvital reaction indicates this is likely a post-mortem artifact, either from resuscitation efforts Or freezing ofthe body. There are non-specific cardiac findings, including moderate dysplasia ofthe atrioventricular nodal artery. However. there is no associated increased septal fibrosis, which can be a potential substrate for cardiac arrhytJunia. There is also miid coronary artery atherosclerosis. but no luminal narrowing greater than 40% w~found. A cardiac arrhythmia related to various ion channelopatbies or coronary vaiiospaSIil cannot be excluded.
Therefore, the cause ofdeath is best classified as undetehnined, and the manner of death is undetennined.
b)(6)-2
b)(6)-2 I. MD ­~
LtCo}, USAF, Me, FS ~
First Chief Deputy Medical Examiner

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DEPARTMENT OF DEFENSE
ARMED FORCESlNSlITUTE OF PATHOL.OGY
WASHINGTON, DC 20308-8000

AFIP-CME-T
PATIENT IDENTIFICATION
AFIP Acc:essiOllJ Number Sequellce
TO; 2~1~1 m
Name
OFFICE OF THE ARMED FORCES MEDICAL
EXAMINER­ -
ARl\oIED FORCES INSTiT~OF PATHOLOGY WASHINGTON, DC 20306-6000 SSAN: ToxicQlogy Accession #: Autopsy: 043002 ME04-434

Date Report Generated: June 30, 2004
CONSULTATION REPORT ON CONTlUBUTOR MATERIAL
AFIP DIAGNOSIS REPORT OF TOXICOLOGICAL EXAMiNATION
Condition of SpeciDlens: GOOD Date of hlcident: Date Received! 6/22/2004
VOLATILES: The HEART BLOOD AND URINE were examined for the presence of ethanol at a cutoff of20 mgldL. No ethanol was detected.
CYANIDE~ There was no cy8nide detect~d in the heart blood, The limit ofquantitation for cyanide b 0.25 mg/L. Nonnai blood cyanide concenttations are less than 0.15 mg/L. Lethal concentrations ofcyarude are greater than 3 mgIL.
DRUGS: The BLOOD Was screened for amphetamine, antidepressants, antihistamines, barbiturates, benzodiazepines, cannabinoids, cocaine, dextrOmethorphan, lidOcaine, narcotic analgesics, opiates, phencyclidine, phenothiazines, sympathomimetic amines and verapamil by gas chromatography, colot test or immunoassay. The following drugs were 4etected:
None were found.
b)(6)-2
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PhD, ABFT
Certifying Scientist, Forensic Toxicology Laboratory­Director, Forensic Toxicology Laboratory Office oftbe Amied Forces Medicai Examiner OffiCe of the Anned Forces Medical ~xamiher
ou O~) 34

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