nine Guantánamo detainees who had alleged abuse, as this review found a correlation between detainees’ symptoms and their allegations of abuse but noted that medical personnel treating these detainees “failed to inquire and/or document causes of the physical injuries and psychological symptoms they observed”.599 Such failure runs contrary to international standards, including the Istanbul Protocol on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.600 278. Several past practices continue to impact the current quality of care provided to Guantánamo detainees. First, the involvement of behavioural science consultation teams in interrogations led to detainees’ severe distrust of medical personnel.601 Other practices carried out by medical personnel also undermined the doctor/patient relationship. This is the case of force-feeding, a practice which is still used in conditions that some hunger strikers have recently described as extremely painful.602 Similarly, while medical personnel no longer participate in security functions such as body-cavity searches, it has been reported that they may still allow the sedation of detainees for transportation and security purposes.603 It can reasonably be assumed that past abuses and current practices such as force-feeding keep fuelling detainees’ distrust of medical personnel. Furthermore, the rapid rotation of medical personnel appears to further undermine the development of a trusting relationship between detainees and medical staff and the effectiveness of medical care.604 Lack of trust is said to remain a significant problem which still compromises the quality of care at Guantánamo.605 279. Lack of timely and appropriate medical care may have an adverse effect on detainees’ ability to meaningfully participate in the proceedings against them. For this reason, defence 599 The Report of The Constitution Project's Task Force on Detainee Treatment, op. cit., note 183, p. 227; Vincent Iacopino and Stephen N. Xenakis, “Neglect of Medical Evidence of Torture in Guantánamo Bay: A Case Series”, PLOS Medicine, 26 April 2011, <http://www.plosmedicine.org/article/info%253Adoi%252F10.1371%252Fjournal.pmed.1001027>. 600 Istanbul Protocol, op. cit., note 313, paras. 67, 69, 72; “Principles on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment”, op. cit., note 564, Principle 6(b). 601 UN Special Procedures, “Situation of detainees at Guantánamo Bay”, op. cit., note 23, para. 76; Ethics Abandoned, op. cit., note 430, pp. xix, 47. In 2004, the ICRC, for instance, reported that detainees did not seek care for fear that medical personnel would pass on the information to interrogators. Lewis, “Red Cross Finds Detainee Abuse in Guantánamo”, op. cit., note 399. For more information about the involvement of behavioural science consultation teams in interrogations, see Part 1-II-A of this report. 602 For more information about the force-feeding of Guantánamo detainees, see Part 1-II-A of this report. 603 Ethics Abandoned, op. cit., note 430, p. 47. 604 ODIHR interview with Brigadier General Stephen Xenakis, op. cit., note 231; United States Military Commission, United States of America v. Al-Nashiri, “Unofficial/unauthenticated transcript of the hearing dated 4/24/2014 from 09:06 AM to 11:20 AM”, p. 3753; “Medical Care and Medical Ethics at Guantanamo: A conference co-sponsored by The Constitution Project and Global Lawyers and Physicians - Post-conference summary”, The Constitution Project’s Task Force on Detainee Treatment website, 2 December 2013, p. 8, <http://detaineetaskforce.org/wp-content/uploads/2013/12/12-2-Conference-SummaryFINAL.pdf>. 605 ODIHR interview with Brigadier General Stephen Xenakis, op. cit., note 231; ODIHR interview with Physicians for Human Rights, op. cit., note 472. See, also, United States District Court for the District of Columbia, Shaker Aamer v. Barack H. Obama, Case No. 04-CV-2215 (RMC), “Petitioner’s motion for judgment on his petition for writ of habeas corpus”, 7 April 2014, p. 9, <http://s3.documentcloud.org/documents/1104737/aamer-ill-motion.pdf>: “Because Joint Medical Group (…) physicians at Guantánamo are accountable to the Joint Detention Group (…) rather than their patients, a relationship of trust and agreement between JMG physicians and their prisoner-patients is impossible. (…) Further, “the ability to collaborate and build physiciantrust at Guantánamo is impossible because [Joint Medical Group] clinicians were often complicit in the abusive interrogations of their patients. (…)With no possibility of sustained doctor-patient trust at Guantánamo, any treatment the [Joint Medical Group] provides in an attempt to rehabilitate Mr. Aamer’s mental and physical fitness will be doomed to fail.” 120