In a new JAMA viewpoint, Boston University School of Public Health researchers Sondra Crosby and Leonard Glantz denounce rectal feeding practices that occurred at these prisons, and call for medical officers who enabled this “medicalized rape” to be held accountable for violating ethical and legal standards.

Nearly 10 years ago, a US Senate Intelligence committee report detailed for the first time the horrors of forced rectal feeding inflicted upon detainees at CIA secret prisons. The victims of this abuse were later transferred to the Guantánamo Bay detention camp for indefinite confinement.

Now, as the country marks the 22^nd year of the opening of Guantánamo Bay, two Boston University School of Public Health (BUSPH) researchers are calling for the medical officers involved in this unethical and discredited practice to be held accountable.

Published in the journal JAMA, Dr. Sondra Crosby, professor of health law, ethics & human rights at BUSPH and Leonard Glantz, emeritus professor of health law, policy & management at BUSPH, equate rectal feeding to torture and argue that medical officers who authorized, ordered, or participated in this nonconsensual and medically ineffective practice have committed acts that meet the legal definition of rape. These officials have never been identified or formally punished for their actions.

“Medical officers are not absolved of ethical and legal responsibility for their actions when they commit heinous acts on behalf of and with permission of the state,” Crosby and Glantz write. “We believe that any CIA physicians and all other medical officers who authorized or participated in the rectal feeding of these prisoners cannot be entrusted to protect the welfare of patients once they return to civilian positions.”

Modern medicine has long rejected rectal feeding, which was once thought to be an alternative method of providing nutrition. CIA officials alleged that this forced feeding was a necessary action to end detainees’ hunger strikes. But last August, a military judge ruled that it was an illegitimate medical practice.

“The sequelae of rape can persist for decades and even a lifetime,” the authors write, stating that anal rape survivors often experience both physical and psychological harms, from depression and posttraumatic stress disorder, to rectal perforation, infections, and chronic pain.

“Both ethical and legal standards require reasonable medical judgment and prohibit providing treatment that cannot benefit a patient,” Crosby and Glantz write. “…Furthermore, international human rights laws, and basic human decency, prohibit participation in cruel, inhuman, and degrading treatment that can constitute torture. If any of the involved medical officers were physicians, they would have violated their fundamental ethical obligations by using their medical skills to intentionally inflict harm on individuals.”

Both Crosby and Glantz have studied health law and human rights issues extensively. Crosby, who is also a professor of medicine at Boston University Chobanian & Avedisian School of Medicine, serves as a court-approved medical expert on torture. In 2008, she and colleagues at Physicians for Human Rights led the first investigation of human rights violations associated with CIA interrogations of detained individuals. Last February, she testified in court to denounce the rectal feeding practices in the secret prisons, describing graphic details of the effects of torture, based on exclusive interviews she conducted with suspected terrorist Abd al-Rahim al-Nashiri.

Identifying the medical officers who enabled or participated in sexual assault by rectal feeding is crucial, the authors conclude, to determine whether legal or professional action against them is warranted.

“The medical profession should not stand silent when its members commit atrocities under the guise of medicine.”