12 February 2010
I-37. AR 190-8 prohibits the photographing, filming, or videotaping of detainees except for camp
administration and intelligence and/or counterintelligence purposes. However, medical personnel are
permitted to photograph a detainee to document preexisting conditions, injuries, and wounds. The
detainee’s identity should be clearly visible. These photographs are invaluable if a claim of unnecessary
surgery or amputation is made. Any detainee who requires amputation or major debridement of tissue
should be photographed. Once taken, these photographs are maintained as part of the detainee’s medical
I-38. Medical surveillance is the ongoing, systematic collection of medical data that is essential to the
evaluation, planning, and implementation of public health and prevention practices. In particular, it
includes medical data related to individual patient encounters; this data is used for calculating disease and
nonbattle injury rates in a defined population for the primary purpose of preventing and controlling health
and safety hazards. Medical surveillance identifies the population at risk, identifies potential and actual
exposures, determines protective measures, and assesses a detainee’s health. Medical surveillance is not
I-39. The data collected from this assessment forms the health status of detainees. It identifies the endemic
and epidemic diseases present in the detainee population, provides the facility commander with pertinent
information with which to monitor changes in the detainee health status, and provides the basis to perform
health interventions as necessary. Medical surveillance data is used to monitor the implementation and
effectiveness of preventive medicine measures and field sanitation and hygiene practices. For example, an
increase of acute diarrheal disease within a subpopulation of the detainees may necessitate an
epidemiological investigation to determine the cause of the outbreak and to ensure that the spread of the
disease is contained. Once the source of the disease outbreak is determined, preventive measures can be
devised and implemented to ensure that there is not a recurrence.
I-40. Health risk communications and instructions can be developed and disseminated to detainees to
promote an understanding of the medical threat faced by the facility. Dissemination can also enhance
compliance with required PVTMED measures, field sanitation requirements, and personal hygiene
standards to counter the threat.
I-41. To ensure the continued health of detainees, international laws require that each detainee be screened
monthly by medical personnel. During this screening, the detainee’s weight is recorded on
DA Form 2664-R, which provides a concise, chronological weight history of the detainee. Significant
fluctuations in weight can signal an underlying medical condition or can indicate that the detainee’s diet is
not meeting nutritional requirements. Any significant fluctuations must be investigated by medical
personnel. Detainees with significant weight fluctuations are given a more thorough physical to determine
if an underlying medical condition exists or if a disease is present. If the physical examination does not
identify the underlying cause, a thorough evaluation of the detainee’s diet and work schedule is undertaken.
Findings and recommendations for diet adjustment are made to the facility commander. Cumulative data on
weight fluctuations is included in the medical surveillance activities conducted at the facility to ensure that
trends are identified as rapidly as possible and that corrective measures are implemented.
I-42. Detainees are also screened regularly for the presence of communicable diseases. Other screenings
include louse infestations, hydration, and other indicators of health status.
I-43. If a detainee has any signs of unexplained physical injuries (such as burns, fractures, severe sprains,
or bruises), medical personnel should ask the detainee about the cause of the injury. However, medical
personnel do not investigate allegations or suspected incidents of abuse. Any cases of suspected abuse,
whether by internment facility personnel or other detainees, is documented and immediately reported to the
facility commander, the supporting U.S. Army Criminal Investigation Command unit, and the detainee
operations medical director.
Medical Support to Detainee Operations
12 February 2010
I-44. Detainees may receive medical care and schedule a sick call at internment facilities. The medical
section of the I/R battalion provides Level I medical care within the facility. The medical personnel
assigned to this section are supported through technical guidance provided by higher headquarters.
I-45. All medications to be administered to detainees must be dispensed in unit doses by medical
personnel. Depending on the detainee’s medical condition, health care providers should prescribe
medications that can be dispensed on a once- or twice-a-day basis when possible. When dispensing oral
medications, medical personnel will verify the identity of the detainee, check the detainee’s hands and
mouth to ensure the detainee swallowed the medication and is not attempting to horde the medications for
later use. The medication issue registry is primarily used to track the medications that each detainee takes
and to prevent medication duplications and potentially dangerous interactions. A local form can be
developed to document the dosing schedule and the receipt and administration of the medication to the
detainee. At a minimum the form should reflect—
• Name of prisoner.
• Medication issued (name and quantity).
• Time and frequency of issue.
• Printed name and signature of person issuing medication.
• Prisoner’s acknowledgment for receipt of medication.
I-46. Medical personnel are required to administer medications to detainees, prepare and maintain accurate
records, and ensure that all medications are taken as prescribed. If a detainee refuses to take prescribed
medications or fails to appear for the administration of medication more than three times, the supervising
NCO is notified. If the attending medical personnel believe that the refusal to take medication or that
missed medication will seriously affect the health of a detainee, the attending physician is notified.
I-47. Emergency medical treatment may be required at any time and any location within the facility.
On-site medical personnel should have a standardized emergency medical treatment set that can be
accessed rapidly and transported to the incident site. The standardized set facilitates accounting for all
medical supplies and equipment that are taken into the detainee enclosure. When possible, the detainee
should be removed from the detainee enclosure and transported to the facility’s medical treatment area. A
guard accompanies the detainee throughout the evaluation. On-site medical personnel treat the detainee
and, if appropriate, release the detainee back into the detainee population. If the detainee’s medical
condition requires treatment beyond the capabilities of the on-site medical team, the detainee is evacuated
to a higher level of care.
VACUATION TO A
I-48. When a detainee requires evacuation to a higher level of care, interpreter support is required to
facilitate medical personnel performing emergency medical treatment en route to the Level 3 medical
treatment facility. Interpreter support may be provided by radio transmission, or an interpreter may be
onboard the ambulance. Medical personnel onboard the ambulance remain in radio contact with the health
care provider at the Level 3 medical treatment facility throughout the evacuation. A guard accompanies the
detainee throughout the evacuation. After treatment, the detainee is returned to the TIF by ambulance if
appropriate. If the detainee is to be admitted to the Level 3 medical treatment facility, the ambulance crew
returns the TIF guard to the duty station. Military police sign the detainee over to the appropriate
authorities at the medical facility before departure. Medical personnel not responsible for the security of
detainees within a facility. In addition, transportation arrangements should be coordinated to return the
12 February 2010
detainee upon restoration of health. The evacuation and medical treatment received are documented in the
detainee’s health record and on the ambulance run sheet.
I-49. When detainees return to the TIF from the hospital, they are examined by the TIF physician. The
hospital provides clear and concise instructions for follow-on care to be given at the TIF. Medical
equipment and supplies that are not normally available at the TIF, but required for the continued care of the
detainees, are provided by the hospital. The TIF physician coordinates with the hospital for any
appointments required for continued care.
I-50. A formulary must be established for all medical treatment facilities that provide detainee health
support that is specifically tailored to the detainee health care mission. The Defense Medical
Standardization Board is a joint DOD activity that provides policy and standardization guidance relative to
the development of deployable medical systems and medical material used for the delivery of health care in
the military health system. In executing this mission, the Defense Medical Standardization Board
establishes and maintains information, to include national stock numbers, on all medications available
within the military health system. This listing is available at the Defense Medical Standardization Board
Web site <http://www.jrcab.army.mil>. The mailing address is Director, Defense Medical Standardization
Board, 1423 Sultan Drive, Fort Detrick, Maryland 21702-5013. The detainee operations medical director
must ensure that pharmaceutical requirements are identified and that a formulary is developed as early as
possible in the mission planning process. Special plans are devised for the following:
Endemic and epidemic diseases in the operational area and specific AO.
Chronic health problems within the operational area and specific AO, to include nutritional
Dosing requirements of various medications (such as requiring administration twice a day versus
four times a day).
Detainee demographics (age, gender).
Medications currently available within the operational area and specific AO for civilian health
Requirements for obstetric and/or gynecological, pediatric, and/or geriatric health care).
Requirements for chemoprophylaxis.
Sufficient stock of medications to combat disease outbreaks within the detainee population
(meningitis, tuberculosis, influenza).
I-51. In addition to medical supplies, the supporting medical logistics unit provides medical equipment
maintenance and repair and optical fabrication and repair services, as required. Coordination for this
support is through the detainee operations medical director.
DENTAL SERVICE SUPPORT
I-52. The scope of dental services available to detainees is determined by the detainee operations medical
director according to established theater policy. Operational dental support (emergency and essential) is
normally available within a joint operations area. Comprehensive dental care is normally provided in a
support base and not in a deployed setting. Internment facilities do not have organic dental personnel or
equipment. Depending on the anticipated dental workload, dental assets may be colocated with the
internment facility. If dental assets are not colocated with the internment facility, coordination with the
supporting dental facility is required. The internment facility must provide the required guard support for
detainees being transported to the supporting dental facility.
VETERINARY SERVICE SUPPORT
I-53. Veterinary support for detainees is normally required to ensure food hygiene and safety support for
meals. Food must be from approved sources. Veterinary personnel must approve food that is locally
procured from the HN. The use of local food is recommended to ensure that the dietary needs of detainees
Medical Support to Detainee Operations
12 February 2010
are met. If the use of meals, ready-to-eat, is required due to mission variables, cultural and religious dietary
restrictions must be considered, as meals, ready-to-eat, contain food items that may be prohibited.
Humanitarian rations are preferred to meals, ready-to-eat. If meals, ready-to-eat, must be used temporarily,
the same standards used for U.S. armed forces must be applied to the duration of use.
I-54. Veterinary support may also be required for MWDs at internment facilities. The support may be
required to maintain good health or to treat sick or injured MWDs.
PREVENTIVE MEDICINE SUPPORT
I-55. Preventive medicine personnel, whether assigned to a military police unit or a supporting medical
unit, may be required to assist in establishing and/or inspecting a facility. Preventive medicine personnel
will also provide detailed guidance to the commander on occupational and environmental health standards,
field sanitation and personal hygiene standards, and base camp assessments and inspections.
I-56. Additional information on establishing field sanitation devices (latrines and hand-washing stations) is
contained in FM 4-25.12 and FM 21-10. Occupational and environmental health surveillance is required
within the facility and when detainees are engaged in work at off-site locations. According to AR 40-5 and
FM 4-25.12, unit field sanitation teams are the first line of defense for ensuring that these standards are
properly maintained. Preventive medicine personnel will provide direct oversight and support to these
teams as necessary.
I-57. Pest management activities are conducted within the internment facility to reduce the incidence of
disease within the detainee population. Such activities require that—
Food preparation areas are screened to exclude flies from exposed food. Food service support to
internment facilities must meet the requirements in Technical Bulletin, Medical (TB MED) 530.
If food is prepared in the camp and detainees work in food preparation, they must receive basic
food safety training. Retained medical personnel may assist in training.
Adequate collection and disposal of refuse are maintained to provide sufficient sanitation within
the facility. If the detainees are preparing their own meals, one 32-gallon container is required
per 17 detainees. Detainees will have more trash to discard because of food packaging and
uneaten and/or spoiled food. If detainees are eating in a centralized dining facility, one 32-gallon
container per 25 detainees is required since more trash would be generated in the food
preparation area and centrally disposed of there rather than being disposed of in the detainee
living area. Preventive medicine personnel are required to ensure that containers are covered to
minimize attracting insects and rodents. These containers must be emptied and cleaned daily.
Latrines and hand-washing devices are established and are maintained daily. The types and
number of latrines established are determined by the number of detainees and the length of time
that they will be held at a location. Field-expedient measures (individual waste collection bags)
may be required at temporary locations, such as the DCP. Facilities must be properly maintained
to control fly populations.
I-58. Preventive medicine personnel inspect water supplies to ensure potability. If detainees are preparing
their own food, additional quantities of water are required.
I-59. Due to differing national standards and practices for food sanitation and preparation, food service
personnel must be instructed on food sanitation and preparation standards to ensure that they know the
standards which will be enforced. Preventive medicine support is required to ensure that food preparation
and dining facility sanitation are maintained to standard. The food sanitation standards contained in TB
MED 530 apply.
I-60. When food is prepared at a central dining facility and brought to the camp in insulated food
containers, particular attention must be afforded to holding temperatures. Additionally, the maximum
12 February 2010
amount of time that can pass between removing food from the container and serving it must be known and
I-61. Detainees may have personal food items within their designated living space. These items should be
inspected to ensure that detainees adhere to food hygiene and safety requirements. Containers used to store
these items must protect them from potential contamination such as insects and dirt. Additionally, if the
food item is sensitive to heat and/or cold, it must be maintained in a manner that will protect it from
I-62. It is possible that a detainee may bring a domesticated animal into the camp and may then request
permission to slaughter the animal. Coordination for veterinary support should be addressed to the
supporting medical C2 unit.
I-63. Preventive medicine personnel also provide training in personal hygiene practices, field hygiene, and
sanitation to detainees. Standards for personal hygiene and sanitation practices should be posted in detainee
areas in a language that they understand.
12 February 2010
Facility Designs and Sustainment Considerations
Although non-I/R-specific military police units initially handle I/R populations,
modular military I/R battalions with task-organized guard companies, MWD teams,
and other necessary support are equipped and trained to handle detainee operations
for the long term. The I/R battalion headquarters is specifically designed to C2 the
support, safeguarding, and accounting of compliant detainees, noncompliant
detainees, DCs, or U.S. military prisoners. The higher headquarters for an I/R
battalion is typically military police brigade, but may also be an MEB.
J-1. As the DOD executive agent, the OPMG has responsibility for detainees. This responsibility is then
delegated to the combatant commander of the affected area. The combatant commander responsible for I/R
operations provides engineer and logistical support for the facility commander to establish and maintain
detainee internment facilities. Planning, coordinating, and establishing I/R facilities must begin during the
build-up phase of an operation. This will ensure that the facility is ready to receive I/R populations at the
start of the operation. I/R facility construction must be included in the planning phase of the operation.
Whether the I/R facility is built by engineers or contractors, military police leaders and their staffs must be
part of the planning process. There are three different facility designs. Each facility must enable the
appropriate segregation, accountability, security, and support of its respective I/R populations. An I/R
facility normally consists of 1 to 8 compounds capable of interning 500 people each and is generally of a
semipermanent nature. Examples below depict the minimum-security requirements. An excellent document
that addresses the planning considerations for all base camp developments, to include I/R facilities, is EP
1105-3-1, produced by the U.S. Army Corps of Engineers.
J-2. There are three basic focused types of I/R facilities: detainee internment, DC resettlement, and U.S.
military prisoner internment. Each facility starts with a modified version (an administrative area and one
compound) that has a limited, 25 percent capability for start-up operations and is then typically expanded in
increments of 25 percent until it reaches the full facility design with maximum capacity. I/R facilities have
a maximum-security area with individual cells to provide individual detention. Based on the situation, some
internment facilities will have individual detention cells only.
J-3. Maximum-security cell blocks consist of portable cells that are stored on pallets and come ready to
assemble. Maximum-security cells can be assembled as stand-alone cells or hooked together to form a cell
block. They can be assembled in a tent or hard structure. Military police can assemble the cell blocks with
minimal engineer support to run the plumbing and electrical systems.
J-4. Lessons learned have resulted in design modifications to the internment facility. (See figure J-1,
page J-2.) The facility is designed to be expandable in 1,000-person increments. The initial facility is
constructed with the administrative area and one 1,000-person enclosure and then expanded by adding (a
maximum of 3) additional 1,000-person enclosures. Each 1,000-person enclosure must be self-contained,
with electric and water capabilities, and available for occupation immediately upon completion.
J-5. Figure J-1 shows a TIF comprised of four 1,000-person enclosures, each with two 500-person
compounds. Each 500-person compound is further divided into four 125-person compounds. This
configuration allows each compound to be isolated and approached from all sides. Compounds are
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Documents you may be interested
Documents you may be interested