CHAPTER 6 : Ongoing Challenges for Survivors

Chapter Six

Ongoing Challenges for Survivors

The experience of rendition and the subsequent treatment of detainees in foreign or U.S. custody have long-lasting effects on the individuals who lived through them, as well as on their families and communities. Expert testimony before the Commission indicated that “being rendered and tortured was a severely traumatizing, destabilizing and damaging experience for the [individuals] who suffered it and these experiences of rendition and torture have left long lasting biopsychosocial consequences in the survivors.” 600
     This chapter draws on evidence-based research on the effects of torture as well as testimony provided during the Commission’s public hearings. In addition, interviews with survivors and major media reports on the lives of both former and current detainees are useful in understanding the repercussions of the RDI program for those who survived it.
     The chapter also includes examples of current challenges and needs expressed by some of the 49 detainees rendered by Aero Contractors. Former RDI detainees and their families have identified five areas that present the most significant challenges to their resumption of meaningful and secure lives. The special needs of those who remain in detention at Guantánamo are addressed at the end of this chapter.


The priorities of survivors of the CIA program are

  • medical, psychological, and social treatment and support
  • family reunification and social re-integration
  • legal status, full rights of citizenship or residency
  • professional employment and access to financial institutions
  • acknowledgment or accountability for their mistreatment.
  • Although these categories are addressed individually below, they result directly or indirectly from the RDI experience and are interrelated. Inability to overcome one of these challenges often exacerbates the other problems, compounding the violations of human rights. For example, enforced disappearance, rendition, and prolonged captivity cause profound psychological suffering as well as long gaps in employment, lost wages, and damaged relationships. The physical and psychological effects of torture complicate family reunification and viability of employment. Forced displacement through repatriation to a foreign country compounds psychological suffering, limits access to support services, and inhibits family reunification. These challenges may also be termed “post-torture psychosocial stressors,” as described in a study of survivors of torture in South Korea.601


    Survivors of the CIA program confront ongoing physical, mental, emotional, and social challenges. Release in and of itself does not restore the individual’s psychological well-being nor reverse the physiological, psychological, and social damages incurred. The U.S. government has not provided any mental health, medical, or social services to survivors of the RDI program.
         Torture harms victims physically and psychologically. Detainees and their families attest to lasting physical and mental suffering.602 Physical suffering results from torture and abuse, lengthy imprisonment, inadequate medical care during detention, and release without access to adequate medical care. For example, Mustafa al Hawsawi had to undergo reconstructive bowel surgery after forced “anal feeding.”603 Mohamedou Ould Slahi testified at the Commission hearings on his need for advanced medical care as a result of his imprisonment in Jordan, Afghanistan, and Guantánamo Bay.604 Saifullah Paracha needs heart surgery.605

    Abou Elkassim Britel “speaks little; it is clear that he has had a terrible experience. He is tense, he is always cold. He needs medical care, and a lot of attention and patience.”

    Physical and mental suffering take many forms in survivors and are often interrelated. The long-term physical effects of torture interfere with work and daily living, including interacting meaningfully with families and communities. Those effects include headaches, persistent pain, hearing loss, visual problems, cardiovascular/respiratory problems, sexual difficulties, and neurological damage.606 Psychological consequences of rendition and torture that may also have physical components include post-traumatic stress disorder (PTSD), alternating between detachment and paranoia, obstruction of human interaction and connection, and “phobia of hope” or a terror of thought of the future.607 Research on the effects of torture also underscores that both physical and psychological torture have a physiological impact. Even though their end results are not the same, both real and mock executions produce physiological responses and tremendous fear. Indeed, the line between psychological and physical torture is blurry, prompting psychologists such as Dr. Rona M. Fields to conclude that victims can be profoundly harmed by both types of torture.608
         Khadija Anna Pighizzini testified to the Commission that her husband, former detainee Abou Elkassim Britel, “speaks little; it is clear that he has had a terrible experience. He is tense, he is always cold. He needs medical care, and a lot of attention and patience.” She added that since returning home, her husband has trouble interacting with his family and others, forgetfulness, and “alternating moments of frenetic activity with others of great passivity.” As a result, he is unemployed and his wife has taken on household responsibilities.609

    Former detainee Abou Elkassim Britel

    Photo courtesy: Khadija Anna Pighizzini

    “How will we live? We both ask, each on our own. ‘I look at him, but I do not recognize him. He gets nervous over a trifle; he cannot go out, but the house is also foreign to him. He suffers — suffers and does not talk about it. ..... Day after day I realize that this condition will no longer leave us: continuous forgetfulness, the humiliation when objects fall from his hands as he is about to grasp them. He carries a huge weight that he cannot share.”

    The mental suffering individuals experienced during and after their detention is profound, and the range of psychological effects cannot be reduced to a single diagnostic category. Clinically, the way torture affects an individual depends on a variety of factors, including the context and length of the torture, the survivor’s culture, and the chronic pain, social isolation, unemployment, and poverty that result from prolonged detention and abuse. Survivors experience a multitude of symptoms and conditions, including anxiety, depression, insomnia, nightmares, intrusive memories of the torture, anger, guilt, shame, memory and cognitive impairment, and, sometimes, psychosis.610
         Evidence of detainees’ mental deterioration and suffering has been documented in legal briefs, media accounts, interviews with psychologists, and detainee and family member testimony. Martha Rayner, attorney for Sanad Ali Kazimi, says of his experience, “It’s so traumatic, he can barely speak of it [. . .] He breaks down in tears.”611 In her testimony to the Commission, Khadija Anna Pighizzini also addressed the lasting effects of her husband’s detention and torture:

    How will we live? We both ask, each on our own. I look at him, but I do not recognize him. He gets nervous over a trifle; he cannot go out, but the house is also foreign to him. He suffers — suffers and does not talk about it. He sleeps many hours a day. Nothing seems to awaken him from his state; he struggles, but every crowded place causes him anguish. He shuns people, preferring solitude. We struggle to understand each other. Day after day I realize that this condition will no longer leave us: continuous forgetfulness, the humiliation when objects fall from his hands as he is about to grasp them. He carries a huge weight that he cannot share.612

    Jamil el-Banna reported similar, ongoing problems resulting from torture and secret detention after the CIA rendered him to an Afghan “black site” in 2003. “I’ve lost the ability to focus and to remember. I could put this phone down here and then forget where I put it. Previously my memory was excellent [. . .] I also have night terrors. My wife knows this best. I wake up scared, lost and sweating. In those moments, I’m remembering those situations. My back is in pain. I can’t stand for more than 10 minutes. I’m taking pills. Sometimes I can’t sleep because I get extremely worried.”613 CIA-style torture “led to post-traumatic symptoms that were severe, chronic and more globally impairing than I have seen in many other survivors of torture.”

    Mental health professionals Dr. Katherine Porterfield and Dr. Stephen Soldz provided testimony to the Commission about the combined neurological and social effects of torture on those who experience it. Dr. Porterfield testified that CIA-style torture “led to post-traumatic symptoms that were severe, chronic and more globally impairing than I have seen in many other survivors of torture.”614 She had treated survivors of torture by various other governments, and observed among RDI survivors “unusually severe and pervasive” symptoms, including “a chronic condition of whipsawing between over- and under-arousal” that manifested as “almost catatonic detachment and bodily collapse in some cases vs. anxious, on-edge states of paranoia and vigilance” in others. Dr. Porterfield continued:

    In my experience, the rupture of human connection was so profound in individuals subjected to this systematic man-made program that [they] expressed a deep inability to imagine connection or even a modicum of normal human interaction in the future [ . . .] They reported pain when feeling anything resembling “trust” because it triggered in them a reminder than human connection can bring severe pain and humiliation [. . .] A third area of severe impairment that I witnessed was what I came to call a “phobia of hope.” [. . .] I believe it clinically originated in the specific experience of the torturing interrogation – the repeated experiences of questioning, coupled with bodily pain and annihilation of the sense of self-autonomy combined to make these men terrified of conversations about their future because it brought them back to previous states of dependence on someone with total bodily control over them. This has led some individuals to literally plead to not be made to think about the future. This was some of the most disturbing clinical symptomatology I had ever witnessed.615 “A third area of severe impairment that I witnessed was what I came to call a ‘phobia of hope.’” ... This has led some individuals to literally plead to not be made to think about the future. This was some of the most disturbing clinical symptomatology I had ever witnessed.


    The impact of RDI program on wives, siblings, parents, and children of victims has been pernicious and widespread.616 It is worth noting that Article 24 of the International Convention for the Protection of All Persons from Enforced Disappearance defines “victims” as “the disappeared person and any individual who has suffered harm as the direct result of an enforced disappearance.”617 “Any individual” is usually taken to include close family members. Thus, the number of survivors of the RDI program greatly exceeds the 119 documented detainees in the SSCI Report (also, see Chapter 1 for more on the U.S. government’s failure to account to the full number of detainees in the RDI program).
         Former detainees face the immense challenge of rebuilding their relationships with their families and communities. This challenge takes different forms depending upon the conditions of release, particularly whether the former captive is released to a host country or repatriated to their country of origin.618
         The conditions imposed by the U.S. government on detainees who are transferred out of U.S. custody typically include some form of probation such as surveillance, monitoring, enforced reporting, or arbitrary “house calls” by police.619 For former detainees, surveillance is a barrier to family integrity, old and new friendships, and secure relationships. For survivors who are repatriated, both the individuals and their families confront the difficulty of re-establishing relationships under duress. Survivors sent to host countries report extreme feelings of isolation, especially when they have been sent to countries where they do not speak the language, share religious or cultural practices, or have any family members. The combination of being marked as a former detainee and ongoing probation conditions exacerbates former detainees’ social exclusion.620 br>     Survivors frequently suffer their own altered status within their families. Men may no longer be able to provide financially for their loved ones, suffering a special humiliation from the loss of breadwinner status, which may be compounded by dependency on other family members. Former detainees face the challenge of coming to terms with missed events such as the births or deaths of family members, in addition to the day-to-day struggle with the physical and psychological effects of prolonged detention and torture.
         RDI survivors consistently report nightmares, depression, isolation, anxiety, intrusive thoughts, hypervigilance, irritability, difficulty concentrating, inability to schedule appointments, memory problems, and insomnia. Compounded by the stressors of new post-detention environments, these conditions significantly reduce survivors’ ability to function in all realms of life.


    As noted above, the ad hoc nature of detainee release from the CIA program means that survivors may be repatriated to their country of origin, country of residence, or to a third-party state.621 In each of these situations, survivors’ legal status may be precarious. When detainees are repatriated to their country of origin, the U.S. government typically imposes ongoing restrictions that infringe on the survivor’s full rights of citizenship. These include the suspension of a passport or other documentation that would allow a former detainee to travel for personal, professional, or medical reasons.
         For example, Mohamedou Ould Slahi, who testified at the Commission’s public hearings and was transferred from Guantánamo home to Mauritania, has not been able to get a passport yet. This is a serious problem due to his need to travel for medical care, some of which is related to his RDI experience.622
         When detainees have been released to third-party states, the agreement between the U.S. and the receiving country varies.623 Some agreements have been for two to three years, seemingly absent any planning for when the initial time period expires. During this initial placement, the legal circumstances vary, although former detainees experience restrictions on movement and temporary residency status that prohibit their full participation in society. Here, too, they are closely monitored, forced either to report regularly to authorities or placed under surveillance.
         Depending on the country, a national ID card is often a prerequisite for access to basic rights such as marriage, registration of children, primary school, and access to health care and other social services. The ID card is also often needed to obtain a driver’s license that might offer freedom of movement and economic opportunity. With neither documentation nor guaranteed status, those who are released from Guantánamo or RDI detention often cannot take such ordinary steps of civic life as obtaining a cell phone, renting or buying a house, or opening a bank account.624


    One of the most urgent challenges survivors face is employment and how to support themselves and their families.625 The lack of an official record of the program and the experiences of each captive, including whether the individual was ever charged with a crime, have varied effects. Even detainees never charged with a crime are stigmatized, labeled terrorists, and struggle to explain gaps in their employment history.
         The challenge of economic stability may be further compounded by the long gap many detainee families faced without their primary breadwinner and by considerable debts incurred through legal fees. Re-entry to the labor market after many years of absence may require remedial professional training, higher education, or both. Given the physical and mental harm caused by torture and other degrading treatment, few survivors are able to maintain a job without ongoing psychological and social support, let alone to advance their careers.626 Survivors often require flexible jobs and employers who are willing to provide them with sufficient time off to address psychological effects of their experience and who understand their possible physical limitations. Jobs that may be flexible are rarely sufficiently well-paying to meet survivors’ needs.
         urvivors also seek access to financial institutions to resume careers or to rebuild a measure of financial security for themselves and their families. For example, detainees express great frustration with the difficulty of opening a bank account (which, as noted above, likely requires a residential address and an official ID document) or in gaining access to credit.


    Survivors face the dual challenges of having to account for their missing years — to extended family, friends, colleagues, potential employers, government authorities — without receiving official documentation of their experience and suffering. The failure by the U.S. to acknowledge that it subjected specific individuals to rendition, secret detention, and torture has profound and lasting negative consequences for survivors.
         While the Senate Report found that 26 RDI prisoners were either described in the CIA’s own documents as mistakenly detained or were effectively treated as such by being given money upon release, no RDI survivor has received an official apology.627 Many have requested one. Mohammed Bashmilah, whose 19 months of solitary confinement in two CIA “black sites” drove him to multiple suicide attempts, asked his attorney in 2014 if the Senate Report meant he might receive an apology or compensation. Neither was forthcoming, and Mr. Bashmilah, who was living in Yemen, was killed in the conflict there in 2016.628 Thus an apology to him is no longer possible, but his widow still seeks “truth, admission of wrongdoing, and an apology for what the U.S. government did to Mohammed and his family.”629 I want an apology. It is only fair to say that someone who has done something wrong must apologize.”

    Abou Elkassim Britel has also spoken of his desire for an apology: “The wrong has been done, sadly. What I can ask now is for some form of reparation so that I can have a fresh start and try to forget, even if it won’t be easy [ . . .] I want an apology. It is only fair to say that someone who has done something wrong must apologize.”630
         Some survivors are wary of any contact with the US government for fear of recapture or of further stigmatization for having been a CIA target. For others, however, official documentation and the transparency it would afford, along with acknowledgment of wrongdoing, would be a necessary first step toward addressing the harms they suffered and continue to suffer.


    Detainees whom the U.S. government continues to hold in Guantánamo Bay suffer from their own set of challenges. Many of those challenges, especially the psychological ones, are compounded by the individuals’ prolonged and indefinite detention (often without charge) and their deterioration from confinement and torture.
         Thirteen of the 49 Aero-rendered detainees are still in custody. Eight of those 13 are classified as “High Value Detainees” and currently detained in the secretive Camp 7 at Guantánamo.631 Here, they are held in “near solitary confinement,” according to the testimony of defense counsel Lt. Col. Sterling Thomas, and still allegedly suffer torture and abuse.632 These detainees cannot speak with family members and only have contact with their attorneys on a limited basis. Lt. Col. Thomas also testified that “several detainees, including [his client] Mr. al Baluchi’s co-defendant, Ramzi Bin al Shibh, have also alleged that the guard force is using noises and vibrations to replicate techniques used against them by the CIA, which result in constant sleep deprivation and related physical and psychological disorders.”633 Lt. Col. Thomas added that Mr. al Baluchi has been denied adequate medical treatment.634

    Former detainee Binyam Mohamed.

    Photo courtesy: Getty Images

    Eight of those 13 are classified as “High Value Detainees” and currently detained in the secretive Camp 7 at Guantánamo.

    As the Center for Victims of Torture (CVT) explained in a recent legal filing, all of the men remaining at Guantánamo face serious medical consequences “associated with the agonizing uncertainty of indefinite detention.”636 According to CVT, the uncertainty and unpredictability of indefinite detention is so extreme, and the loss of control over detainees’ lives so complete, “that it seriously harms healthy individuals, independent of other aspects or conditions of detention.” Indeed, “medical examinations have documented indefinite detention leading to profound depression and vegetative symptoms, with all the attendant degradation of multiple aspects of health.” These include:636

  • severe and chronic anxiety and dread
  • pathological levels of stress that have damaging effects on the core physiologic functions of the immune and cardiovascular systems, as well as on the central nervous system
  • depression and suicide
  • post-traumatic stress disorder (PTSD)
  • enduring personality changes and permanent estrangement from family and community that compromise any hope of the detainee regaining a normal life following release.
  • Of course, these effects are worse for detainees who were tortured or similarly traumatized before being subjected to indefinite detention: “Lacking any control, and having no sense of what will happen next, re-stimulates the kinds of experiences [survivors] suffered.”637
         Moreover, like other challenges discussed above, the effects of indefinite detention are not limited to survivors themselves. “When a loved one is indefinitely detained, families are separated; parents, spouses, and children can suffer — and have suffered — similar feelings of uncertainty, unpredictability, and uncontrollability, leading to the physical and psychological effects described above.”638 For both detainees and their families, regular communication and in-person visits would be essential to restore relationships and to assist the captive individual in developing and maintaining human connections essential for recovery from severe trauma.
         For survivors of the CIA RDI program who remain detained indefinitely at Guantánamo, rehabilitation services are inadequate or lacking in many instances. Indeed, according to CVT, rehabilitation cannot occur while indefinite detention persists.639 At minimum, survivors must be given a sense of control over key aspects of their lives, have their sense of safety restored, be offered trusted and consistent human connections, and be treated by skilled and experienced providers.640 In many ways, CVT has argued, Guantánamo “is the antithesis” of these basic requirements:

    The military is in complete control over all aspects of detainees’ lives. The men remain held captive — indefinitely, with all the attendant health consequences — by the government responsible (directly or indirectly) for their torture, and in a setting both replete with common triggers of PTSD symptoms and one that will forever be synonymous with torture. According to former Guantánamo medical personnel, trust is essentially nonexistent. That is not surprising given the role that some psychologists and psychiatrists played in the design and implementation of abuses detainees suffered.641


    Survivors of the CIA’s RDI program face ongoing challenges at many levels. Release, the first step away from abuse, constitutes neither physical nor psychological relief, rehabilitation, nor promise of a viable future. Damage to survivors’ legal, economic, physical and psychological health, family, and social needs are deeply intertwined and long lasting. The deaths of detainees without having received acknowledgment or redress emphasize the point that justice delayed will sooner or later be justice denied.