Emails between Army Officers re: Preventive Medicine at Incarceration Facilities

'
bX8)-2
ICOL OTSG .
From: IbX13)-2' 1: COL OTSG
Sent: To: Friday, November 6)4 7, 2003 8:14 AM I COL 0180
Subject: RE: Preventive medicine at EPW and Incarceration Facilities

10(8)-2'I ,b?PM
Thanks for the advice, : worksjOr the i

SGTi as their PM NCOIC. My
consulting.relaticonship withiou i

is based more upon friendship than positional relationship. I think he is like most American Soldiers - trying to help the locals as much as cur own folks. I a lot overi
saw this Afghanistan.
1
13)(0-2
/r,

Original Messagei
From:r 1iICOL OTSG
Sent: Friday, November 07, 2003 8:07 AM

COL OTSG

i

OTSG
Sob:!ect: RE: Preventive medicine at EPW and Incarceration Facilities

.•i
r"}2 this entire issue is a legal one--the status of these p •d this internment
bX6}2
-

facility-sounds like. an Iraqi :prison, ,not an EPW camp. Maybe spouse )(6)-2
nay be available for an informal legal eagle consult—Otherwise I would ask ourkoH'I SJA, COlAbx04i
1, for an opinion as to the status of these facilities. It's unfair (and rather silly) for this SGT in Iraq to be looking to OTSG for guidance. Who does he work for--then-1
i

Original Message From: O(6)-2' I COL OTSG Sent: Thursday, November 06, 2003 3:15 PM
To: 1.x0-2 Iwo).
.bX13)-2
Subject: RE: Preventive medicine at EPW and Incarceration Facilities

COLi

nd COL Do either of you M s now 'guidance regarding how host nations under occupation can
bXe)-2
operate their jails? SGT is the preventive medicine (PM) NCO supporting an MP

Battalion in Iraq. He con•uc s PM surveillance of both MP-operated EPW/detainee

facilities and HN-operated jails. His questions appear below my lengthy response.
Thanks very much.

V/r, re)-2
COL, MS, USAR

thm,
Falls Church, VA 22041-3258

L'SN 312-76:­
703-681

703-681

301-461

,bX13).2
Your questions fall more into the realm of State Department, DoD, DA, and MP policy than
preventive medicine guidance. You need to float these issues up the chain of command to

1
MEDCOM - 394
the C-9,civil-military operations personnel.

My opinion based upon:my reading of-AR 190 ,8 and excerpted below, is that if we, the U.S.
military, run an EPW, civilian internee, or detainee facility, we must run it according to
US standards, e.g., we provide water from Our system, treat sick or wounded with our
medical assets, etc. If, on the other band; the Iraqis run a facility that holds only
Iraqi criminals and no personnel (EPWs, CIs, or detainees) on behalf of the US, then the
:raqis can operate the facility according to their own standards — if, of course, any
exist now. So that leaves the third option - we place US detainees into Iraqi jails and
expect the Iraqi jailers to take care of them until we want the detainee for
interrogation. Probably the worst option unless we exercise control over the Iraqi
jailers. In that case I-think the AR outlined below would apply just as if KBR were
running the jail.

I do not know the status of civil law'within Iraq. Do the public health laws,
regulations, and standards (if any) that existed under the Baath party regime of Saddam
Hussein still apply? Who would enforce them (e.g., Health Ministry for drinking water and
sewage infrastructure) if they do? The US EPA requirements would not apply to Iraqi
infrastructure. WHO standards might. But I think the answers to those questions must
come from the C-9.

With regard to your question about improving the Iraqi prison sanitary infrastructure, I

think you have three options, all of which would have to go up through the MP Bn Cdr:

1) Request ORHA pay for the improvements.

2) Work with the C-9 to have a non-governmental or international organization (NGO/IO)

like Amnesty International pay for improvements.

3), Have the Iraqi government pay for it.

You can try to do what you can to provide theIragis with own policies and guidance for
preventive medicine at US-operated EPW-facilities: Basic sanitation standards, as you've
said, are different in:Iraq, Afghanistan, or Egypt, for that matter, than they are in the
US, UK, or Canada. I thin the NGOs and IOs would agree that you cannot impose a first
world solution in a third world country. The HN does not have the expertise or funds to
maintaini

So the best bet for an Iraqi jail to provide sanitation facilities might be
like those we established at the Short Term Holding Facilities (SHTF) at Kandahar (see
attached photo) - an immersion heater, some buckets, soap, shampoo, toothbrushes & -paste,
and a seepage pit over which the prisoners could perform personal hygiene.

For the overarching DoD Directive (2310.1) on EPWs and detainees, see:
http://www.dtic.mil/whs/directives/corres/pdf/d23101_081894/d23101p.pdf

Your main reference will be AR 190-8, Enemy Prisoners of War, Retained Personnel, Civilian
Internees and Other Detainees. This is a joint document (Army Regulation 190-8, OPNAVINST
346:.6, AFJI 31-304, and MCO 3461.1) available on-line at
http://www.usapa.armyemil/pdffiles/r190_8.pdf.
See below for sections that might be of use.

AR 190-8, Enemy Prisoners of War, Retained Personnel, Civilian Internees and Other
Detainees.
Paragraph 1-4.g., Responsibilities, says JTF commanders will -

(I) Provide for an EPW, CI and RP camp liaison and assistance program to ensure the
protection of U.S. interests per the Geneva Conventions upon the capture and transfer of
EPW, CI, RP, and ODs to a host or other nation.

(2; Plan and-procure logistical support to include: transportation, subsistence, personal,
organizational, and NBC clothing and equipment items, mail collection and distribution,
laundry, and bath for EPW, CI and RP.

(6) Identify requirements and allocations for Army Medical units in support of the EPW, CI
and-RP Program, and ensure that the medical annex of OPLANs, OPORDs and contingency plans
includes procedures for treatment of EPW, CI, RP, and ODs. Medical support will
specifically include:

la) First aid and all sanitary aspects of food service including provisions for potable

water, pest management, and entomological support.
fb) Preventive medicine.
(c1 Professional medical services and medical supply-

(d) Reviewing, recommending, and-coordinating the use and -assignment-of medically trained
EPW, CI, RRand,:0D-personnel-and

2
MEDCOM - 395
medical material.

(e) Establishing policy for medical repatriation of EPW, CI and RP and monitoring the
actions of the Mixed Medical Commission,

OBVIOUSLY you are ensuring your MP unit complies with items (6)(a)&(b).

Wow if any of your prisoners were medical personnel in--the Iraqi Army, then according:to

the following-paragraph, they should be treating•Iraqi EPWs and detainee's.

Paragraph 1-54 General Protection Policy.
'. Medical Personnel, Retained medital personnel shall receive as a-minimum the benefits
at&protection given toEPW and shall-also be- granted all facilities necessary to provide
for the medical-care of EPW. They shall-continue to exercise their medical functions for
the 'benefit of EPW, preferably those belonging to the armed forces upon which they depend,
within the scope of the military laws and regulations of the United States Armed Forces.
They shall be provided-with necessary transport and allowed to periodically visit EPW
situated in working detachments or in hospitals outside the EPW camp, Although subject to

-

the internal discipline of the camp in whidh they are retained-such Personnel may not be

compelled to carry out any work other than that concerned with-their medical duties. The

senior medical officer shall be responsible-t6 the camp-military authorities for

everything connected with the activities of retained medical personnel.

CHAPTER THREE-covers_EPWs• and , Retained Personnel (medical personnel of the opposing. force)
Regarding the facilitiet themselves, they•must be maintained•with-proper-health-and. -
hygiene standards. , Seethe f011owing••paragraph:

3-2. EPW internment faCilities

a.
The operation:of all EPW internment facilities is governed by the provisions of the
Geneva Conventions.

b.
The theater commander-remains responsible-for the Iodation of EPW facilities, EPW/RP
may be interned only in premises located on land- and affording-proper health-and hygiene
standards. Except in -extreme circumstances, in-th• bett interests of the individual;
EPW/RP will not be interned in correctional facilities housing military or civilian:
prisoners. Prisoners will not normally be interned in unhealthyareas-; or where the-
climate proves to be injurious to them, and-Will -be removed as -soon -as possible-to a more
faVorable climate,

e.
EPW/RP will be quartered'under conditions as favorable as those for-the force of the detaining power billeted in the same area, The conditions shall make allowance for the habits andcustoms of the prittnereand shall in no case be prejudicial to their health. The foregoing shall Apply-in particular to the-dormitOrie-eot-EPWIRPas it regards both total surface and minimum cubic space and the general installation of bedding and blankets. Quatterefurnished -to'EPW/RP must be protected from dampness, must be adequately lit and heated (particularly between dusk and lights-out), and must have adequate precautions taken against the dangett-of fire. In camps` accommodating both sexes, EPW/RP will be provided with-Separate fatilitiet -for women. When possible-consultthe preventive-medicine authority in theater for provisions of minimum living space and sanitary facilities.

f.
The daily food rations will be sufficient in quantity, quality, and variety to keep
EPW/RP in good health and prevent loss of weight or developmeht of nutritional
defitiencies.

Account will be taken of the habitual diet of the -prisoners`.

..PW-/RP who work may be given additional rations when required.

31 Sufficient drinking water will be supplied . to EPW/RP. -

:4)The use of tObacto will be permitted -in designated smoking areas.

:5) EPW will, -at-far as-possible; be-associated with the preparation of their meals and
may be employed for that purpose in-the kitthens,- Furthermore, they will be given means of
preparing additional food in their possession. Food service- handlers must have training in
sanitary methods-of foOd service.

(-6) Adequate premises will be provided for messing.

(7) Collective disciplinary measures affecting food are prohibited.

is Hygiene and -medital care:

(l) The United States is bound-to take all-sanitarymeasures necessary to ensure clean and
healthy camps, to prevent-epideMics. EPW/RP will have access, day and night, to latrines

3
MEDCOM - 396
that conform to the rules of hygiene and are maintained in a constant state of
CleanlineSS: In any camps in which women EPW/RP.are accommodated, separate latrines will
be provided for them. EPW/RP will have sufficient water and soap for their personal needs
and laundry. The necessary facilities and time will be made available for those purposes.
The supporting EPW/CI PSYOP unit can assist in maintaining and improving health and
sanitary. conditions by producing and-disseminating informational products concerning
proper:hygiene, sanitation; and food preparation,:where required,

;2) Every camp will have an infirmary. EPW/RP with a contagious disease, mental condition,
or other illness, as determined by
the medical officer, will be isolated from other patients. A list of endemic diseases, of
military importance can be obtained from the theater surgeon or preventive medicine

EPW/RP will be immunized and reimmunized against other diseases as recommended by
the Theater Surgebn. EPW/RP suffering: from serious disease, or whose condition
necessitates special treatment4,surgery„,brjlospital care, must be admitted to any
military or civilian medical unit where such:treatment can be given. Special facilities
wiii be available for the care and rehabilitation, of the disabled, particularly the blind.
EPW/R? will be accorded the attention. of:medical personnel of the power on.,wklich they
depend and, if possible, of. their nationality, EPW/RP will not be denied medical care. The
detaining authorities shall, upon request, issue. to every EPW/RP who has undergone
treatment, an official certificate indicating the nature of the illness or injury, and the
,.::ration and kind of treatment received. A duplicate of this certificate will be forwarded
tc the ICRC. The detaining, authority will also ensure medical personnel properly complete
the SF 88 (Report of Medical. Examination), SF.600 (Chronological Record of Medical Care
and DA Form 3444 (Treatment Record). The cost of treatment will be borne by the United
States.

(3)Medical inspections of EPW/RP will be held at least once a month, where each detainee
will be weighed and the weight_recordedon DA Form 2664-R (Weight. Register). DA Form, 2664-
R will be reproduced locally on 8- by 5-inch card. A Copy for reproduction purposes is
located at the back of this regulation. This form: is for the use of Army only. The purpose
of those inspections will be to monitor the general state of health, nutrition, and
cleanliness of prisoners and to detect contagious diseases, especially tuberculosiS,
venereal disease, lice, louse-borne diseases and HIV.

(4)EPW who,, though not attached to the medical service of the Armed Forces, are
pysicians, surgeons, dentists, nurses, or medical orderlies may be required to exercise
their medical functions in the interests of prisoners of war dependent on the same power
after being certified per Paragraph 3-15: They will continue to be classified as EPW, but
will receive the same treatment as corresponding . RP (medical personnel), They will be
exempted from any other work.

:1.) Experimental research will not be conducted on EPW/RP.

CHAPTERS FIVE and SIX pertein to Civilian Internees or Detainees. Essentially CIs must be
billeted in the same manner as EPWs and

6-1. Internment FacilityL
a-,I,Ocation. The theater commanderVillbe_responsible for the location of the CI
internment facilities within his or her command. The CI retained temporarily in an
unhealthy, area :or where the climate is harmful to their health will be removed to a more
suitable place of internment as soon as possible.

b. Quarters. Adequate shelters to ensure protection against air bombardments and other
hazards of war will be-.provided and.precautions against fire will be taken at each CI camp
and branch camp.

:11 All necessary and possible measures will be taken to ensure that CI shall, from the
outset of their internment, be accommodated. in buildings or quarters which afford every
possible safeguard as regards hygiene and health„ and provide efficient protection against
the rigors of the climate and the effects of war, In no case shall permanent places of
internment be placed in unhealthy areas, or in districts the climate. of which is injurious
to CI.

(2) The premises shall be fully. protected from dampness, adequately heated and lighted, in
particular between dusk and lights
out. The sleeping quarters shall be sufficiently spacious and well ventilated, and the
internees shall have suitable bedding and sufficient blankets, account being taken of the
climate, and the age, sex and state of health of the internees.

-

(3) Internees shall have for their use, day and night, sanitary conveniences which conform
to the rules of hygiene and are constantly maintained in a state of cleanliness. They
shall be provided with: sufficient mater ancisoap tpr their daily personal hygiene and for
washing their personal laundry; installations-.and facilities necessary. for this purpose

shall be provided. Showers.or :baths shaIl ,also:be available. The-necessary time shall be

set aside for .washing and for bleaning

and

6-6. Medical Care and Sanitation

a. General.

(1)Dental, surgical, and-medical treatment will-be furniShed free to the CI.

(2)A:medicalofficer will examine each CI upon arrival at a camp and monthly thereafter.
The CI will not be admitted into the general population until medical fitneas is
determined. These examinations will detect vermin infestation and communicable diseases
especially tuberculosis, malaria, and venereal-diseaSe. They will also determine the state
of health, nutrition, and-cleanliness of 'eachi

DUring-these examinations, each CI wil:
be weighed, and the weight will be recorded on DA Form 2664-R:
Each CI will'be immunized-or-reitMunized as prescribed by theater policy.

g. Sanitation.i•

(1)Aygisne and-sanitation measures will-conform to those prescribed in AR 40-5 and
related regulations.- Camp commanders-wi-il- •••
conduct periodic and detailed sanitary inspectionS.

(2)A detailed sanitary -order meeting the specifit'needs of each 'CI• camp or-branch camp
will'bepublished by the CI ramp •commande•. Copies-will be'reprOduced•in a language that
:he. CI. understands and will be-posted in each compound:

(3)Each CI will be provided with sanitary supplies, service, and facilities necessary for
their-.personal cleanliness and sanitation.•Separate sanitary facilities will be provided ­for each sex,
:4) All CI -will. have-at their disposal, -day and-night,--latrine facilitieS conformibg to

sanitary rules- of the Army-. -

.i

. Grislinal.MSssade i

From:1"

Sent:_- Wednesday,---November 051. 2-003 231 PM - :

,o, r04?i. •'COL OTSG

, •.i

Subject:. Re: Preventive medicine at EPW and Incarceration Facilities

Thank-.youlor your .aSaist

The attachments you sent were on 1- the confusion related to possibly having a TB MED for =p/EPWand Refugee-ops _(,excellent idea) and 2- Delousing Issues. Thankfully, the folks atCRPPM North sguared -meaway:On.the delCusing issue.before 1-came...over here and-I passed Lt along-toPtheXHFPW41R.ONPM.perSonnel-who:didn!-.t have such. info•yet,i
gdess the-mainissue at hand is bur.. current,dealingswith. the City.cf---Baghdad Jallsand the-transition ofE?W/IR camps to full.•fledged facilites,. ,Theintent is to turn them over to the Iraqis and
gOiAg that direction,i . However,, during. the-transition. several questions. havei
-developed in which )114manitarianguidance is_unclearandheeds tO-beepecified. This could
also help in-Afghanistan as well.

Q..lestionone Since_ the jail:and:prison. lacilitieSHate provided water : from -local sources, and these sources have been deemed-non-potable by, our.standards, do-we-allowthe-prisonersccdrihk/usethe water. they have.been: usingall_their lives? To add to that dilemma, dowefollow,WHO s,tanclax0s4 .BPA,..betore we. deem it potable, or.do we•.supply them-with-water from our treated trailers/ROWPUs etc. If that is the case, who pays for it, bottled water,. etc? We barely. have enOughtraileraand blivetts. for our. owp troops,- The- Iraqis are, afterall.going.. to reclaim the operation in full once we (US) deem them capable, butthe water supply/distribution system isnot. going to be replaced;-- Note-: • the , source. treatment.plant$ are slowly_improving : andeasier to. upgrade., yet -the infrastructure 'for • distribution is a virtual. nightmare of poor lines, poor.pressure, line breaks, and cross­connections/backflow. Cost for.repairireplacement. unimaginable at present. - If•th:ere-is• guidance, from • •i
•
higher up, we. have yet..tocbtAiP.Hit...at the...1314.user•.level.

-
Question 2- Same scenario for sewer systems- Jail cells with : open sewer "trenches",
backed up sewer lines in cells, etc add to the rodent population, ants, roaches, etc. How
do we address, or should we address upgrading these third world facilities. I have noted
it in numerous reports for my chain of command but what can they really do about it. ­mean, they really don't have much of a sewer trap for their toilet "holes". We are so
used to having thesefacilties look pristine in the states but can we expect the same
nere?

Question 3- If theywon't,pick,up their own garbage outside their homes, continue to have
landfills (i.e.. piles and piles of garbage) on the sides of the roads, how are we supposed
to get them to pick up the garbage outside the jail walls. We clean them up, they re-
dump. Its their culture,. so should have a protocol for dealing with it?

Question 4- with .no,place toaat, drinkshower, etc other than in their cells, how do we
keepproper sanitation alive? TheAailsnavenoother rooms to .use. barely space as it is
for them to sleep. This causes even more problems as you can imagine.

I believe firmly, that as long as we use "3rd World" facilties, structures and utilities

in a 3rd World, we will continue to have 3rd World problems. Aside from that, their

culture is definitely a conflict with our standards. I am trying to educate the Iraqi's,

as is part of my job as PM, yet for them to change their standard of living may be a

problem. I mean, shaking their left hand is netbn,myto.do list.

Any thoughts or guidance out there would be great.. I'm winging it as we go, but future
PMers could really use the guidance in the aboveareas, I have had many an interesting
discussion with MP and. Medical personnel. alike which causes these "moral dilemma's" to
arise: Their Health vs. Geneva Covention vs. Our mission. Mission first always. Right?

Sincerely,

SGI "J*0-2

PS I didn't want to send this out to all of the individuals you had on the email as cc'd

for

of saving face with "OPSEC", however, several of them could very well have the answers to ti -s •uestions, or at least make those decisions if not done already. I believe COL 5)(62 has civilian experience in water/wastewater.
.

. Oriainal. Message. -7-7.,

(b)(13)-2
From: " 3403)-2.

COL OTSG"
Daze: Wednesday, November 5, 2003 1:35 pm
Subject: Preventive.medicine..at EPW and Incarceration Facilities

:boy2

sGT.

I recalled that a flurry Of email activity occurred back in the spring of 2003

-

regarding EPW PM provisions. The first attachment provides an information paper on PM
support for EPW facilities. The :second PttaPtImPntie the flurry record that relates mainly
to delousing

.

Bottom line.: Identifying specific PYNTMED policies apdtechniques for hands on

applications in an EPW camp: environment was ,best accomplished by speaking with AMEDD

personnel who had previously been involved with either EPW or refugee camps.

bX6)-2
During ODS did your unit perform PM su.•ortfor EPW camps? If so do you have any

5(81-2
lessons learned or guidance .for SGT 0

• Nce-2
Do you know if cliPPM started work on

,EPW PM, fact sheet or TB MED as discussed in COL
IPOK info paper?

:bX6)-2
Atch one refers to some hiSteriCal,N0rX dPne by P•v on EPW camps, especially WRT
b)(8)-2
entomological support. Can y• iles to see what he found and

••k back into COL
if possible provide it to SGT 13)(8)-2
6

•

Thanks to all.

:bX111)-2
V/r,
COL, MS, 1TSAR _

? mom:

iLNO to OTSG
5111 Leesburg Pike, Room 53B
Falls Church,, VA 22041-3258

CSN 31277 61
—:bX3)-1
7C3-681
7C3-681
3C1-4617

(b0)-2.
• QaTiTA1

MARSAM.

-Fronur
Sent:-Wednesday, November 05, 2003 1:09 PM

,b)(6)-2
To iCOL OTSG
Subject: Re: RE: RE; Preventive medicine inspection forms

Thanks Sir,

Maybe I can assist the incoming PM Gal with new info for a
smoother life for
her .stay in lovely. Downtown Baghdad.

'1,)(0)-2

i

Original Message

b)(6)-2
:b)(B)-2
"i
Date: Tuesday, November 4, 2003 3:58 i

iCOL OTSG"

e.
Subject:-RE:, RE: Preventive medicine inspection-forms

!b)(6)-2
i

SGT
I have not found anything specific,on,EPW or jail PM. I have to

i
contact a „

i.i
presenter_at the, Army. FHP ,Conference who spoke on thissubjvct.

i
.0(8)-2 .
y/r, :c0L.

ii

, Original Message
i

From: i Sent: Friday, October 31, 200,3 3:21 PM TO : :b)ie)-2 1COL OTSG Cc : Pm-2
:b)(6)-2

Subject: Re: RE: Preventive medicine inspection forms

Thanks Sir,

They missed me again, Six. One LED down.and: 300.00 to go. I.

had
a close
call today on the road, but thankfully no one was injured. Keep
praying, it
seems to be workingwonders,

Anyway, I do have _coppiesof these forms, if not all of them on

.

che
PM disks.

However, I am taking care of all the jails in Baghdad and

haven't

had the

opportunity to perform many field ento surveys. The only field

site I have

»,iS at, the HiAp,.which.thankfully falls under the 14th PM.

Otherwise I would:

dive in. In my earlier email I was looking for jail/prison

:_criteria,We (US
:,Armyl-may have put into place (ie. inspection forms, programs,
ezo) which
,may, help me to identify something I may have missed along the
way.

already "gin'd" something together for them to implement.

Unfortunately, I

i

doubt they will, but persistence is the key, right? I couldn't
locate anything on the PM disk.i

Any ideas?

As for the food issue, I am aware of multiple locations where

the

local food

has been savored from time to time, Yes:,- the "revenge" has been

felt, uh,

i

not by me of course. I would never try one of their

cheeseburgers

or pizza

» or chicken, not me.

CPTiI visited ABu Ghraib the other day. It's coming

alon

nicely with the little city look. I did note that one of the
MP's

mentioneda "restaurant" that opened a week or 2 ago- local
fcoas.

J7.:st thought I'd

pass it along in case they didn't let you know.

Have a Happy Halloween, (I won't).

:1,X6)-2
SGT

iro-2

Oriainal Message

» From: " )(8)-2iCOL OTSG"

Date:i, 2003 9:4 pm

Subject: RE: Preventive medicine inspection forms

» $GT

These a achments provide additional preventive medicine

inspection forms.

i
These ar bxei

• ..logy collections and reporting.

).2

V/r, COL
•

8