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Damage or destruction of property. Individuals often damage or destroy property to harass the
detaining power or to impede or prevent normal operations of the facility. This type of disorder
can be controlled by identifying, isolating, and segregating individuals involved.
H-54. Unorganized disorders are characterized as being spontaneous in nature. They begin because of the
actions of a single individual. Like all disturbances, their prompt control is essential.
H-55. Violent crowd tactics may be extremely destructive. They may include physical attacks on fellow
detainees, guards, or government property; fires; or bombings for the purpose of an escape, a grievance
protest, or tactical or political advantages. Only the attitudes and ingenuity of crowd members, the training
of their leaders, and the materials available to them limit their use of violent tactics. Rioters may commit
violence with crude, homemade weapons or whatever items are at hand (rocks, bricks, bottles). If violence
is planned, rioters may easily conceal makeshift weapons or tools for vandalism.
H-56. Rioters may erect barricades to impede movement or to prevent a control force from entering certain
areas or buildings. They may use vehicles, trees, furniture, fences, or other handy materials to erect
barricades. In an effort to breach barriers, rioters may throw grapples into wire barricades and drag them
down. They may use grapples, chains, wire, or rope to pull down gates or fences to affect a mass escape.
They may use long poles or homemade spears (tent poles) to keep control forces back while they remove
barricades or to prevent control forces from using bayonets.
H-57. Rioters can be expected to vent their emotions on individuals, troop formations, and control force
equipment. They may throw rotten fruits or vegetables, rocks, bricks, bottles, improvised bombs, or any
other objects at hand.
H-58. Rioters may direct dangerous objects like vehicles, carts, barrels, or liquids (such as boiling water,
oil, or urine) at troops located on or at the bottom of a slope. On level ground, they may drive
commandeered vehicles at the troops, jumping out before the vehicles reach the target to breach roadblocks
and barricades, and scatter the control force formation.
H-59. Rioters may set fire to buildings or vehicles to block the advance of the control force formation. Fires
may also be set to create confusion or diversion, destroy property, or to mask escapes.
H-60. Riots are organized or unorganized. In organized riots, leaders of detainees may reorganize the
detainee population into quasimilitary groups. These groups are capable of developing plans and tactics for
riots and disorders. Riots could be instigated for—
An escape. Detainee leaders organize a riot as a diversion for an escape attempt. The attempt
may be for selected individuals, small groups, or a large mass of individuals.
A grievance protest. Grievance protests could be organized as a riot. Under normal
circumstances, a riot of this type will not be of an extremely violent nature. It may turn violent
when the leaders attempt to exploit any successes of the riot or weaknesses of the detaining
Tactical purposes. Riots are often organized for the sole purpose of causing the detaining power
to divert troops. This tactical move limits the detaining power’s ability to perform its mission.
Political purposes. Riots are often organized as a means of embarrassing the detaining powers
in their relations with the protecting powers and other nations or for use as propaganda by the
nations whose nationals are involved in the riot. They may also be organized as a means of
intimidating individuals or groups that may have been cooperative with the detaining power.
H-61. Unorganized riots are characterized at their inception as being spontaneous in nature, although they
could be exploited and diverted by leaders at any subsequent stage of the riot into a different type. Crowds
may start as a holiday celebration, a group singing, a religious gathering, an arson event, or any other type
of gathering that might lead to group hysteria. Under determined leadership, the pattern of these gatherings
could change to that of an organized riot.
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Medical Support to Detainee Operations
As participants in the Geneva Conventions, detainees in U.S. custody receive medical
care consistent with the standard of medical care that applies to U.S. armed forces in
the same area. (See AR 40-400, AR 190-8, DODD 2310.01E, DODD 2311.01E, the
FM 4-02 series, FM 8-10-6, and FM 27-10.)
MEDICAL AND ETHICAL CONSIDERATIONS OF THE
TREATMENT OF DETAINEES
I-1. Medical personnel are well trained in, and guided by, the ethics of their professional calling. These
training and ethical principles, coupled with the requirements of international laws as they pertain to the
treatment of detainees during a conflict, ensure the ethical treatment of all sick and wounded personnel.
Note. See Military Medical Ethics Volume I and Volume II for more medical information. These
manuals are available electronically at <http://www.bordeninstitute.army.mil>.
I-2. The Geneva Conventions specifically prohibit certain acts and specify that all detainees will receive
humane treatment. Prohibited acts include murder, torture, medical and scientific experimentation, physical
mutilation, and the removal of tissues and organs for transplantation. Additionally, causing serious injury,
pain, or suffering is prohibited.
I-3. Torture can take many guises in wartime situations. Historically, it has been used to extract tactical
information from an uncooperative detainee. However, it has also been applied to punish and/or inflict pain
and suffering. Regardless of the rationale, the torture of detainees is prohibited. Medical personnel do not
participate in the torture of detainees, to include—
Administering drugs to facilitate interrogation.
Designing psychological strategies for interrogators.
Advising interrogators on the ability of a detainee to withstand torture.
I-4. The detaining power is prohibited from conducting medical and scientific experimentation on
detainees. This prohibition arose from experiences in World War II. Since the prisoner is in the custody of
the detaining power, any consent to the experiment is suspect as the prisoner may feel coerced to provide
consent. This prohibition does not extend to the introduction of new treatment regimens and/or
pharmaceuticals when there is a substantiated medical necessity and withholding the treatment would be
detrimental to the health of the detainee.
I-5. Due to the nature of warfare, numerous combatants and/or noncombatants may sustain injuries that
require the amputation of an unsalvageable limb to save their life. Amputation that is based on a medical
necessity and conforms to existing standards of medical care is not considered physical mutilation and,
therefore, is permitted.
I-6. With advances in medical science, transplanting organs in peacetime has become an accepted method
of treatment for certain conditions. However, during wartime, with the exception of blood and skin grafts,
organ transplants are prohibited. Although the recipient’s health status benefits from the transplant, the
donor’s health status does not. As with the discussion of consent for medical experimentation, the consent
of donors in the custody of the detaining power is suspect as donors may feel coerced by their status into
providing consent. Transplanting organs and/or tissue from cadavers is also prohibited as the practice could
12 February 2010
lead to allegations that donors were permitted to die to harvest their organs. Geneva Protocol I does permit
the exception of blood and skin grafts but provides stringent controls. Tissues obtained must be used for
medical purposes, not research or experimentation. The tissue donor must voluntarily consent to the
procedure, and records must be maintained.
I-7. Geneva Protocol I reiterates the right of an individual to refuse a surgical procedure, even if that
procedure would be lifesaving and falls within existing medical standards. A surgeon may not feel ethically
bound by a refusal in the case of a minor or an individual whose judgment is impaired by injury or illness.
Documenting the issue, whether it is the patient’s refusal (in writing, if possible) or the surgeon’s decision
is an essential step in ensuring that allegations of abuse are not forthcoming.
SUSPECTED OR ALLEGED ABUSE, TORTURE, OR SEXUAL
I-8. Medical personnel are obligated to report any suspected and/or alleged abuse, torture, or sexual
assault through the chain of command and to the U.S. Army Criminal Investigation Command. Medical
personnel report any suspected abuse and/or torture through technical channels to the detainee operations
medical director. Medical personnel are also required to document actual, alleged, or suspected abuse in the
detainee’s medical record.
I-9. Medical personnel have contact with detainees in a variety of settings. Medical personnel must
document any suspicious medical occurrences during—
Initial detainee screening. Preexisting medical conditions, wounds, fractures, and bruises
should be noted. The documentation of these injuries and conditions provides a baseline for each
detainee and facilitates the identification of injuries that may have occurred in the internment
Routine detainee sick calls. Detainees should be visually examined to determine if unusual or
suspicious injuries are apparent. If any are present, the health care provider must attempt to
determine from the detainee how the injuries occurred. Any injuries that cannot be explained, or
for which the detainee is providing evasive responses, are noted in the medical record and
reported to the chain of command and functional medical channels.
Facility visits. The reasons for entering the detention facility may include conducting sanitary
inspections, providing emergency medical care, and dispensing medications. When in the
facility, medical personnel must be observant. They must immediately report to the chain of
command anything which might indicate that detainees are being mistreated. If they observe a
detainee being mistreated, they must take immediate action to stop the abuse and then report the
I-10. If a detainee alleges that abuse, torture, or sexual assault has occurred, the health care provider must
report the allegations to the facility commander, CID, and detainee operations medical director. Medical
personnel are not required to investigate the allegation beyond what is required to render appropriate
medical treatment, except in the cases of alleged rape and/or sexual assault. Cases of alleged rape and/or
sexual assault require that medical personnel comply with the standard procedures for the collection,
preservation, and processing of rape kit evidence. Detainees alleging sexual assault or rape will be tested
for sexually transmitted diseases, and female detainees will be given a pregnancy test as specified in the
MEDICAL SUPPORT PROVIDED TO INTERROGATION TEAMS
I-11. Under the provisions of the Geneva Conventions, medical personnel are prohibited from engaging in
acts that are considered harmful to detainees. Medical personnel providing direct patient care for detainees
will not participate in, or provide medical information to, interrogators. Medical personnel are—
Medical Support to Detainee Operations
12 February 2010
Authorized to halt any interrogation or interrogation technique if the detainee’s health or welfare
Authorized to stop an interrogation immediately if a detainee requires any medical treatment
during the interrogation.
Authorized to perform preinterrogation and/or postinterrogation medical evaluations at their
Required to perform preinterrogation and/or postinterrogation medical evaluations on the request
of an interrogator.
Required to document preinterrogation, during interrogation, and postinterrogation medical care
in detainees’ medical records.
Required to develop procedures for documenting medical care delivered during or due to an
I-12. Behavioral science consultation team members are authorized to make psychological assessments of
the character, personality, social interactions, and other behavioral characteristics of interrogation subjects
and to advise authorized personnel performing lawful interrogations. Those who provide such advice may
not provide medical care for detainees, except in emergencies.
I-13. Medical personnel must consider the welfare of their patients. If a detainee has a medical condition
that could deteriorate during interrogation and result in a health crisis for the detainee, the health care
provider should inform the interrogation team of the existing medical limitations. For example, a detainee
who is diabetic may have dietary restrictions and requirements and a need to take medications on a
I-14. The roles and responsibilities of medical personnel associated with detainees vary. The following
paragraphs describe those personnel and their activities.
I-15. The theater Army Surgeon for the Army Service component command appoints a detainee operations
medical director to oversee and guide all elements of health care delivery to detainees within the theater.
This ensures a comprehensive, continuous assessment of critical mission tasks; facilitates the rapid
identification of deficiencies; and enhances the timely resolution of health care delivery issues.
I-16. The detainee operations medical director is responsible for—
Advising the theater commander on the health of detainees.
Providing guidance, in conjunction with the command SJA, on the ethical and legal aspects of
providing medical care to detainees.
Recommending the task organization of medical resources to satisfy mission requirements.
Recommending policies concerning medical support to detainee operations.
Developing, coordinating, and synchronizing health consultation services for detainees.
Evaluating and interpreting medical statistical data.
Recommending policies and determining requirements and priorities for medical logistics
operations in support of detainee health care. This includes blood and blood products, medical
supply and resupply, formulary development, medical equipment, medical equipment
maintenance and repair services, optometric support, fabrication of single-vision and multivision
optical lenses, and spectacle fabrication and repair.
Recommending medical evacuation policies and procedures and monitoring medical evacuation
support to detainees.
Recommending policies, protocols, and procedures pertaining to the medical and dental
treatment of detainees. These policies, protocols, and procedures provide the same standard of
care provided to U.S. armed forces in the same area.
12 February 2010
Ensuring that medical records are maintained on each detainee according to AR 40-66 and
Ensuring that monthly weigh-ins are conducted and reported as required by regulation and
Planning for and implementing preventive medicine operations and facilitating health risk
communications (to include preventive medicine programs to counter the medical threat).
I-17. The military police battalion has organic medical personnel to provide limited Level I medical care
capability and preventive medicine services within the internment facility. When a detainee operations
medical director has been designated within the joint operations area, these medical personnel are under the
technical guidance of the detainee operations medical director.
I-18. These medical personnel assist with in-processing detainees by providing the initial medical
examination. They provide routine sick call services and emergency medical treatment and coordinate with
the supporting medical units for Level II and above care. They maintain medical records, to include
DA Form 2664-R. When the supporting medical unit is colocated with the internment facility, the unit
scope of practice, schedule, and duty assignments are coordinated through the supporting medical unit.
I-19. Medical personnel organic to maneuver units may be required to provide emergency medical
treatment, area medical support, and medical evacuation at the POC and to temporary concentrations of
detainees at DCPs and DHAs. In early-entry operations, the senior medical officer (brigade surgeon) serves
as the detainee operations medical director until follow-on forces are deployed and a detainee operations
medical director is designated for the joint operations area.
I-20. The medical resources required to support detainee operations are task-organized based on the
mission variables. The detainee operations medical director determines the medical support requirements
and develops and provides technical guidance for all medical resources engaged in detainee medical
operations. This guidance is directed to appropriate medical personnel through their technical channels.
I-21. The detainee operations medical director is designated by the medical deployment support command
commander to develop and provide technical guidance or the medical aspects of detainee operations
conducted throughout the joint operations area. Technical guidance is exercised throughout all echelons of
medical channels and affects all medical personnel and units delivering health care to detainees. Technical
Medical services provided at DCPs and DHAs, to include limited medical screening, emergency
medical treatment, preventive medicine measures (hygiene and sanitation), and the medical
evacuation of seriously injured or ill detainees through medical channels. The echelon
commander must provide guards and/or escorts when detainees are evacuated through medical
channels; medical personnel cannot perform guard functions.
Medical services provided in the internment facility, to include—
Initial medical examinations.
Medical treatment (routine care, sick call, emergency services, hospitalization, medical
consultation, and specialty care requirements).
Preventive medicine (medical surveillance, occupational and environmental health
surveillance, hygiene and sanitation standards and practices, pest management activities,
water potability, dining facility and services hygiene, food preparation practices).
Documents you may be interested
Documents you may be interested