36. Several sources indicate that the force-feeding process may inflict gratuitous pain and suffering on hunger strikers. Should these allegations be accurate, the force-feeding process in itself would amount to cruel and inhuman treatment and potentially to torture. For this reason, it is crucial for the US government to be more transparent on the forcefeeding process. 37. Involvement of medical staff in the treatment of detainees. Medical staff has contributed to the development and use of the CIA enhanced interrogation techniques under the RDI programme and in abusive interrogation methods at Guantánamo. They have allegedly also provided advice on detention conditions that would foster the detainees’ dependence on their interrogators, participated or have been present in interrogations at Guantánamo, among others. Such practices contradict standards forbidding medical personnel from taking part in torture, directly or indirectly. 38. Involvement of other OSCE participating States in acts of torture and ill-treatment. If the allegations formulated by various and concurring sources prove to be true, the participation or mere presence of interrogators, sent from several OSCE participating States to Guantánamo, when they “knew or ought to have known” that the detainees under interrogations faced a real risk of torture, ill-treatment or arbitrary detention, could be understood as condoning such practices and would violate international law. 39. Freedom of religion or belief. Reported past and present violations of the right to freedom of religion or belief are of concern. This right is protected under the ICCPR and relevant OSCE commitments and is a norm of customary international humanitarian law. Such violations have included cases of desecration of religious items, the use of discriminatory detention and interrogation techniques intended to offend detainees’ religious sensitivities, and the explicit or implicit association of Islam and terrorism by US authorities. Although the United States has taken positive measures to allow for the free exercise of detainees’ religion “consistent with the requirements of detention”, individuals held at Guantánamo continue to face hindrances to pray communally, in particular when held in segregated cells and/or when participating in hunger strikes. High-value detainees’ access to religious materials and a Muslim chaplain has been allegedly restricted without further explanation. International standards on freedom of religion or belief provide for the absolute nature of the right to have or adopt a religion or belief of one’s choice, and foresee potential limitations to the right to manifest such religion or belief, but under strict conditions only. National security does not constitute a legitimate ground for restrictions. 40. Right to health and obligation to secure medical attention. OSCE commitments and international human rights and humanitarian law require states to provide detainees with healthy living conditions and quality medical care, including treatment as needed. Medical examinations should be guided by the principles of clinical independence, medical ethics, autonomy of patients and informed consent. Medical care should not be conditioned on detainees’ compliance or co-operation with prison authorities and interrogators. Medical personnel have a duty to document and report signs of abuse or neglect as well as to report when the conditions of detention affect the physical and mental health of detainees. 14