Early this year, evidence began to emerge of alleged abuses of Gazans held at Israel’s Sde Teiman military detention facility, which was established after the Hamas terrorist attacks of Oct. 7, 2023. Documented in reports by Israeli human rights groups (e.g., here and here), United Nations agencies, and investigative journalists (e.g., here, here, here, here, here, here, and here), they have included dozens of accounts of detainees subjected to severe and repeated beatings, rape (which was captured on video and broadcast in August on an Israeli television station), constant shackling, continuous blindfolding, suspension from a chain, and other forms of torture, as well as inhumane and degrading treatment including keeping detainees in diapers in unsanitary conditions and denying them appropriate food. Several Gazan health professionals detained at Sde Teiman and later released without charge, from among the more than 260 health professionals reportedly detained by Israel since October 7th, have reported similar abuses.
Some Israeli medical personnel have spoken up about these abuses (e.g., here, here and here), along with some soldiers, which has played an important role in calling attention to the abuses and their catastrophic health consequences for detainees, such as amputations arising from continuous handcuffing. According to the Israeli human rights group B’Tselem, detainees at Sde Tieman were among at least 48 detainees from Gaza and an additional 12 from the West Bank who have died in Israeli detention facilities in the year since October 7th.
Torture and inhuman treatment of detainees are war crimes. They also put medical staff in a severely compromised ethical position. As reported in the Israeli newspaper Haaretz, a physician whistleblower wrote that the conditions in Sde Teiman were making “all of us—the medical teams and you, those in charge of us in the health and defense ministries—complicit in the violation of Israeli law…”
As with the infamous U.S. abuse of prisoners during the Bush administration’s “war on terror” of the early 2000s, which both of us have studied, Israeli detention practices at Sde Teiman have renewed serious questions about the enlistment in or acquiescence by health professionals in detainee abuse, how they responded, and who should be held to account.
There are both similarities and differences across the U.S. and Israeli cases, but the response of some health professionals in both reveals the all too common acquiescence in and non-reporting of torture of detainees. One difference is that there have been a few health professional whistleblowers in Israel, while in the United States just one nurse and not a single physician at Guantanamo Bay or CIA “black sites” ever publicly spoke out about torture. In both the U.S. and Israeli cases, some health professionals actually embraced intentional mistreatment of detainees, with some U.S. psychologists designing, participating in, and publicly defending torture. In neither country have any participating health professionals been held to account. Another difference is that in the United States, major medical associations protested the abuse and the role of health professionals in it, and strengthened their ethical standards on interrogation in response. The Israeli Medical Association, by contrast, has so far not issued a statement about the abuses, ignoring the accounts of whistleblowers from within the profession, and its leaders vouched for the medical care provided at Sde Teiman.
How the Sde Teiman Detention Facility Came to Exist
Immediately after Hamas’ terrorist attacks against Israel of Oct. 7, 2023, emergency legislation enacted by the Israeli parliament (the Knesset) expanded Israel’s Unlawful Combatants Law, authorizing detention of anyone from Gaza suspected of hostile acts or of posing a threat to Israel. New provisions in the law allow for detention of Gazans without access to a court for up to 75 days, and initially denied detainees the right to see a lawyer for up to six months (later reduced to three months). When individuals designated “unlawful combatants” appear in court, they can be denied information about the charges against them if that information is deemed classified. These provisions made it much more difficult for detainees to challenge their detention or the conditions of their confinement. Further, to detain the dramatically increased numbers of Gazans held by Israel, the military established a new detention facility at Israel’s Sde Teiman base in the Negev desert. Over the course of the war, this facility has held more than 4,000 detainees from Gaza. Unlike West Bank detention facilities, it is not subject to the rules and protocols of the Israeli Prison Service and its medical staff has consisted largely of civilian volunteers.
At the same time, in the immediate aftermath of October 7th many public hospitals in Israel refused to provide medical care to captives from Gaza. Israel’s Minister of Health supported these refusals and directed that detainees from Gaza not be transferred to public hospitals unless they faced an immediate threat to their lives or their conditions risked irreversible and severe disability. Instead, the Ministry of Health set up a “field hospital” at the Sde Teiman detention facility. According to evidence collected by Physicians for Human Rights Israel, as of mid-September, some hospitals have continued the policy of not accepting Gazan detainees for treatment and others now admit detainees but offer them only minimal treatment, even for very serious conditions, and discharge them quickly back to detention facilities.
Systemic Undermining of Medical Care at Sde Teiman
Reported abuses at Sde Teiman have included indifference to, even contempt for, detainees’ health needs. According to multiple reports collected by CNN, guards at Sde Teiman regularly declined to send detainees with serious medical conditions to the field hospital, whether for chronic diseases, wounds from combat, or the consequences of beatings, constant shackling, and other abuses.
When detainees were sent to the field hospital, clinicians there could not adhere to fundamental ethical standards of impartial and appropriate care and exercise of independent medical judgment. As examples, whistleblowers report that the Sde Teiman facility was inadequately supplied with essential medicines like anti-seizure medications, causing some detainees to suffer lengthy epileptic seizures. It was also not set up to offer complex care or to treat systemic infections, forcing clinicians to provide whatever sub-standard treatment they could, because there were no other options. One Israeli medic, interviewed by CNN, said medical personnel at Sde Teiman were sometimes commanded by military personnel to perform procedures for which they were unqualified. During clinical examination and treatment, detainees were typically kept blindfolded, fully restrained, and they were prohibited from speaking, all of which prevented them from interacting with clinicians and in some case even being aware that they were being examined by a health professional. While clinicians could request removal of restraints for patient treatment, the final say was with military authorities, not doctors.
Medical Complicity and Medical Whistleblowing
The mistreatment of Gazan detainees at Sde Teiman, including medical complicity in it, has been rightly compared to Guantanamo and the secret CIA detention facilities set up in other countries after the al-Qaeda attacks on the United States of Sept. 11, 2001. The CIA and Department of Defense engaged health professionals to contribute, directly or indirectly, to brutal interrogations, and they limited health professionals’ exercise of independent medical judgment, in violation of their core ethical obligations of beneficence, nonmaleficence, and impartiality. At Guantanamo, Department of Defense Behavioral Science Consultation Teams, staffed by psychologists and psychiatrists, were called on to advise interrogators on strategy, including identifying exploitable detainee vulnerabilities, such as phobias, for use in interrogation, and to monitor the infliction of torture. A nurse who refused to participate in force feeding there faced discharge and criminal charges, which were dropped only after a year-long public campaign on his behalf.
At CIA black sites, U.S. physicians engaged in practices labeled as medical but that amounted to torture, such as “rectal feeding,” which is not a legitimate medical procedure. Clinicians were also instructed to limit initial medical assessments to 15 minutes, refrain from prescribing time-dependent medications that could interfere with brutal interrogations, and forgo any care that might interfere with the interrogation strategy of deliberately-induced anxiety. Despite their professional ethical obligation to report torture and cruel, inhuman and degrading treatment of detainees, there is no evidence that any physician did so. Some health professionals even publicly defended their participation in interrogations that amounted to torture.
At Sde Teiman, a handful of Israeli health professionals to date have spoken out publicly against abuses they have witnessed. Notably, the medical staff at Sde Teiman were civilian volunteers, so they are not subject to military retaliation like that experienced by the Guantanamo nurse for speaking out. Other Israeli medical personnel interviewed have expressed conflict about the abuses against detainees and their own roles at the facility. One said, “We only talked amongst ourselves about what happened there – including our frustrations over the way things were handled… Even though I saw injuries at Sde Teiman that justified taking the patient to a proper hospital, I understood that it would be wrong for me to make my opinion known to the management. It was implied that there was no point.”
Other medical personnel have expressed agreement with the dehumanizing policies or permitted their hatred of the detainees to affect their practice. One expressed the view that their role was to ensure that detainees “were not treated compassionately and that we did not do more than the bare minimum for the detainees,” which is an obvious breach of the ethical principle of medical impartiality and could violate international humanitarian law. Other reports reveal some clinicians also embraced keeping detainees in blindfolds and shackled during medical evaluation. Some reportedly endorsed blindfolding because not making eye contact helped distance them from the detainees, but this too is contrary to sound clinical practice. And, according to Dr. Mohammed Abu Salmiya, the director of Al-Shifa Hospital in Gaza, who was detained for eight months and then released without charge, a doctor and nurse participated in beating him.
In early 2024, an Israeli physician whistleblower first communicated privately with officials about detainee abuse at Sde Teiman, which led to a visit from a Ministry of Health ethics committee. This visit, however, led to no substantial changes. At the end of March, the doctor followed up in a letter to the Ministers of Defense and Health and the Attorney General, expressing horror at what he was seeing. According to an account of his letter initially reported by Haaretz in April, the doctor described the constant shackling and blindfolding of detainees, violence inflicted on them, unsanitary and humiliating conditions, lack of medical supplies and equipment at the hospital, and more. He wrote that half the patients in the field hospital were admitted because of injuries related to shackling and cited the fact that, in the week that he wrote the letter, two prisoners had their legs amputated due to these injuries, which he said, “unfortunately is a routine event.” He concluded that, as a result, health professionals were complicit in legal violations “regarding the operation of prisons including medical treatment, and perhaps worse for me as a doctor, in the violation of my basic commitment to patients, wherever they are, as I swore when I graduated 20 years ago.”
Dr. Yoel Donchin, an anesthesiologist at Sde Teiman, subsequently reported caring for a detainee whose ribs were broken by guards and whose lungs were damaged and required emergency surgery. Examination of this patient also revealed evidence of sodomy, including a tear in the lower bowel. Donchin said he was criticized both for treating terrorists at all and for reporting what he found to authorities.
In circumstances where detainee abuse becomes known, it is critical for leaders in the health professional community to stand up for medical ethics, support medical whistleblowers, demand stopping ongoing abuses, and promote accountability. The United States record in this regard has been mixed. Some major medical organizations issued new ethical standards (which were urged by the authors here, among many others) prohibiting direct medical involvement in or monitoring of interrogations. But the American Psychological Association collaborated with the Department of Defense in facilitating the involvement of psychologists in interrogations and altered this stance only long after evidence emerged that psychologists had participated in torture.
As in the United States, in Israel some leading Israeli physicians and bioethicists affirmed that, notwithstanding the traumas of October 7th, health professionals are obligated to follow’ ethical and legal duties to treat detainees appropriately and humanely (the authors did, however, argue that security considerations can make complete equality with civilian patients unrealistic, such as equal access to family visits). But as reported by Shomrin, an Israeli investigative journalism organization, Dr. Yehiel Bar-Ilan, a medical ethicist at the Faculty of Medicine at Tel Aviv University who interviewed a number of health professionals at Sde Teiman, noted unethical medical conditions and practices at Sde Teiman. But he also seemed to endorse some of them, such as mentioning without comment that doctors at Sde Teiman sometimes kept detainees in diapers and fed them only liquids so that they would not need to be touched or moved as often. Inconvenience, of course, is never a justification for inhuman and degrading treatment.
The Israeli Medical Association (IMA), like medical organizations throughout the world, has adopted policies and ethical standards requiring physicians to provide care impartially to wartime detainees. Both before and after October 7th, it reaffirmed the ethical obligation to treat captured enemies based on medical need alone, including for those suspected or proven to have committed acts of terrorism. But in recent months the organization’s leaders have vouched for the government’s operations at Sde Teiman, despite multiple reports by health professionals about apparent gross violations of this principle there.
The IMA sent an ethics delegation to Sde Teiman in the spring, but its members were kept anonymous and the group excluded anyone who had any association with independent organizations like Doctors without Borders, and it has yet to release a report. On April 24, 2024, Dr. Yossi Walfisch, Chair of the IMA Ethics Board and a member of the delegation, along with the IMA’s President and its Director of Law and Policy, published a letter in an ethics journal saying they “could attest to the fact that the prisoners [at Sde Teiman] are receiving appropriate medical care within the necessary precautions taken to ensure the safety of the medical staff.” The three authors did not mention the by-then multiple reports from clinicians about abuse and denial of care. Instead, they conceded only that there may have been discrete instances of ethical violations, which they blamed on the existential trauma of October 7th.
Accountability
Accountability for atrocities against detainees in wartime and manipulation of health professionals to facilitate abuses is critical, both for prevention in the future and to provide justice for those harmed. But it has proven to be at least as challenging in Israel as in the United States. In response to the whistleblower’s account reported in Haaretz, the Defense and Health Ministries initially denied his account, claimed all domestic and international laws were being followed at Sde Teiman, that the dignity of prisoners was being respected, and that the facility was regularly monitored. They added that specific allegations would be investigated.
In May, as more information emerged about Sde Teiman, Israeli human rights groups filed a petition with Israel’s High Court seeking its closure. A few days later, the Chief of Israel’s General Staff ordered an internal investigation into conditions and practices, and the following month he told the court that the IDF had transferred hundreds of detainees to other detention facilities and planned to transfer others. The IDF, however, continued to deny systematic abuse and claimed whistleblower reports were inaccurate and ill-founded. In August, under continuing pressure from petitioners and the court, the IDF admitted that some detainees were kept shackled and blindfolded for long periods of time, but still contended the practice was lawful. By the end of August, the number of detainees there declined from more than 700 to a few dozen. Meanwhile, an IDF criminal investigation into the rape allegation went forward, and on July 29 military police came to Sde Teiman to hold several soldiers for questioning.
In September, the High Court of Justice declined to grant the petition by the human rights groups to close Sde Teiman, stating the conditions there had changed with the reduction of the population and based on representations by the government that it had reduced the use of restraints and was providing food and medical treatment in accordance with the requirements of the law. The court nevertheless chose to formally order that the government adhere to law in its treatment of detainees, which would be a gratuitous order if it were already happening.
Both individual and institutional accountability, however, has remained elusive. The only reported criminal investigations of abuses at Sde Teiman, so far, have targeted low level soldiers and are related to a single act of rape and reportedly some detainee deaths. There have been no indications that commanders and Ministry of Health officials are being investigated for policies and acts that compromised care or facilitated abuse, such as policies requiring routine constant blindfolding and shackling or limiting the availability of medical resources and the professional autonomy of clinicians. In the past, the IDF has only rarely investigated complaints of criminal violations against Palestinians by Israeli soldiers (see here and here) and not held commanders to account for authorizing abusive practices or establishing an environment that led to abuses. As evident elsewhere, including in the United States, accountability for health professionals who breach ethical and legal obligations to detainees in wartime remains a rarity worldwide.
One barrier to accountability is public and political opposition. Within the Israeli public, there has been substantial public opposition to accountability, and even vocal support for the abuse of detainees, which was also seen in the U.S. “war on terror.” In the United States, as in Israel, public opposition was facilitated by American officials dehumanization of detainees and calling them “the worst of the worst” (though many were actually innocent), which provided a rationalization for torturing them. In Israel, the political opposition to accountability appears even stronger and more violent. The trauma of October 7th, the promotion of the idea that there are “no uninvolved civilians” in Gaza, and the consequent denial of the detainees’ humanity, gave license for some Israelis to celebrate detainee abuse. Meanwhile, high-level political opposition to accountability in Israel has been pressed by far-right politicians and activists like National Security Minister Itamar Ben-Gvir, whose ministry controls the police and prison service (though not Sde Teiman). He wrote on X that “one of the highest goals I have set for myself [as minister] is to worsen the conditions of the terrorists in the prisons…” When military police came to Sde Teiman to hold soldiers for questioning about the rape of a detainee, far-right activists and politicians violently sought to storm the facility to prevent military police from arresting the soldiers. And when Hanoch Milwidsky, a lawmaker in Benjamin Netanyahu’s Likud Party, was asked if it was legitimate to insert a stick into a detainee’s rectum, he responded that, “If he is a [Hamas fighter], everything is legitimate to do.”
When many in the public and their political leaders support abuse, and when Israeli medical professionals working in detention facilities cannot count on their professional association to support them when they report abuse, it exacerbates the risks they take from blowing the whistle on abuse. Worse yet, the failure of medical organizations to support clinician whistleblowers who are seeking to protect human rights and professional ethics implicitly gives support to politicians and the military who subvert them.
Conclusion
As with Guantanamo Bay, Abu Ghraib, and the CIA black sites, even closing Sde Teiman will not end the need for meaningful investigations of what happened there and broader accountability beyond prosecuting a few low-level soldiers. The U.S. failure to hold its torturers to account damaged the standing of the United States and of international law. It also had enormous long-term costs and, according to Human Rights Watch, it has provided “a ready excuse for countries unwilling to prevent or prosecute torture in their own countries.” The United States has since, slowly and painfully, reformed its interrogation and detention practices, but it has continued to refrain from bringing perpetrators to account. As a result of this failure, the prosecutor for the International Criminal Court (ICC) rightfully launched an investigation into allegations of U.S. torture and other possible crimes arising out of the conflict in Afghanistan. Unfortunately, in 2021 he ended that investigation, possibly as a result of U.S. pressure.
Learning from the U.S. experience, Israel’s government should move assertively toward rigorous and transparent investigations and holding individuals at all levels accountable for establishing policies and systems that predictably led to detainee abuse. But if credible investigations are not carried out, then ICC prosecutors should launch an investigation into the conduct of the high-level Ministry of Health and other officials who set up the systems that led to detainee abuse and that required Israeli health professionals to violate their oath. At the same time, Israeli medical organizations should publicly and forcefully support the medical whistleblowers, speak out against torture, stand up for medical ethics, and acknowledge that health professionals – some perhaps willingly, but others clearly unwillingly – have been made complicit in abuse at Sde Teiman.
Hamas’ attacks on Israel were horrific, and the resulting trauma on Israelis is pervasive and ongoing. But moral and legal standards of conduct can’t be influenced by the brutality of the enemy. In fact, a brutal enemy might make it even more important to treat detainees properly. As George Washington once wrote, with respect to British soldiers captured in the American Revolution, “Treat them with humanity and Let them give no reason to Complain of our Copying the brutal example of the British Army in in their Treatment of our unfortunate brethren who have fallen into their hands.” The United States has had a difficult time heeding this wise council from its first president, with terrible consequences. It is tragic that Israel is following that same path.
Acknowledgements: The authors thank Guy Shalev, Ph.D., executive director of Physicians for Human Rights Israel, for his insights.
(Authors’ note: Dr. Wynia reports unpaid service on the Advisory Council of the U.S.-based non-profit, Physicians for Human Rights, which is not affiliated with the Israeli non-governmental organization Physicians for Human Rights Israel mentioned in this article. Statements in the article are his own and should not be attributed to any organizations or groups with which he is affiliated.).