The US government detained at Guantanamo a prisoner who was hospitalized for auditory hallucinations he suffered as a teenager and had twice attempted suicide in 2009 while imprisoned at the detention facility.
In March of 2009, Hajji Nassim was found with cuts on both sides of his neck. A month later, he lacerated both of his arms. He blamed the latter suicide attempt on "jinn," Arabic for demons. Nassim then spent a year at the prison's behavioral health unit. After he was released, he was administered before bed one milligram of Risperdal, an antipsychotic used to treat schizophrenia, to quell his suicidal thoughts and auditory and visual hallucinations. The medication apparently kept him stable.
But despite his well-documented history of mental illness, US officials justified Nassim's continued detention by insisting that he was a prominent al-Qaeda figure. He was one of the last prisoners transferred to Guantanamo, arriving at the prison in September 2007.
However, Nassim, who was known as Inayatullah at Guantanamo, would eventually succeed in taking his own life. In the dead of night on May 18, 2011, he secured a white bed sheet to a pipe in the recreation area adjacent to his cell, stuck his head through a noose he made and hung himself. He was found at around 3:30 AM. First responders on the scene cut the bed sheet and attempted to revive Nassim in the cell and at a medical treatment facility he was taken to on the island. But efforts to save him failed. Nassim was officially pronounced dead nearly 90 minutes later. He was the eighth prisoner reported to have died at Guantanamo.
Those are the findings contained in Nassim's autopsy report obtained by Truthout under a Freedom of Information Act (FOIA) request from the US Army Medical Command. The autopsy report does not identify the camp where Nassim was detained. But it is believed that after he was released from the behavioral health unit he was held in Camp 6.
The medical examiner who performed the autopsy on Nassim opined that the prisoner died from "asphyxia due to hanging."
"He was found suspended from a horizontal pipe in the cell block's recreation area with a bed sheet around the neck,"the autopsy report said.
Nassim had one last meal before he died. His stomach contents contained partially digested food.
But the mystery behind Nassim's death endures. How was the 37-year-old prisoner, who was under constant video surveillance and checked by Guantanamo guards, at a minimum, every three minutes, able to walk out of his cell with a bed sheet, tie it to a pipe in the recreation yard and hang himself?
The answers are shrouded in secrecy. The Naval Criminal Investigative Service (NCIS) conducted an investigation into Nassim's death, but two years later, the details remain classified. However, a separate inquiry by United States Southern Command (SOUTHCOM), Joint Task Force-Guantanamo's (JTF-GTMO) higher command, claims that guards at the prison weren't following or enforcing the prison's standard operating procedures, Truthout has learned.
Beyond a press release issued by the Pentagon announcing his capture, Nassim's autopsy report is the only document the government has ever released about him. He does not appear in the detainee assessment files released by WikiLeaks two years ago, nor is there any documentation that shows he appeared before a Combatant Status Review Tribunal (CSRT), a hearing overseen by the Defense Department to determine if a Guantanamo prisoner meets the definition of "enemy combatant."
Nassim's attorney said he never belonged at Guantanamo.
"This is really a sad mental health case ... starting from childhood," Paul Rashkind, Nassim's federal public defender, told The Miami Herald after Nassim's death. "To me, this is a human tragedy."
A review of Nassim's medical records by the medical examiner said the prisoner was hospitalized at "age 15 for auditory hallucination."
Rashkind said Nassim was never associated with al-Qaeda. He told the Herald Nassim ran a cell phone shop in Iran, near the Afghanistan border.
Pictures of Nassim have also never been released. His autopsy report said that he was 5'8'', weighed 160 pounds and had black hair, a black mustache and a long beard, both with gray hair. He had "multiple scars" on the right side of his neck, which the autopsy report says was "probably" related to his two previous suicide attempts, and scars on his left shoulder and left flank that are of unknown origin.
The revelation in Nassim's June 7, 2011, autopsy report that he had been treated with the antipsychotic Risperdal, a medication whose side effects include seizures, is significant because the identities of drugs given to Guantanamo prisoners' are closely guarded secrets. But toxicology tests, according to the autopsy report, did not show the presence of Risperdal or any other drugs in Nassim's blood stream.
Risperdal was also one of the drugs identified in the autopsy report of Yemeni prisoner Adnan Latif, who the Pentagon said committed suicide last September by taking a fatal dose of antipsychotic medication. Sources familiar with the NCIS probe into Latif's death told Truthout Risperdal was "part of the cocktail" Latif took that contributed to his death.
Latif's autopsy report remains under wraps. Truthout sought a copy of it through a FOIA request. However, John Peterson, the head of the US Army Medical Command's FOIA office, denied our records request in November, stating, "the autopsy report ... is part of an ongoing Naval Criminal Investigation and is not releasable" under a FOIA exemption "which prohibits the disclosure of information that could reasonably be expected to interfere with an ongoing law enforcement investigation."
Truthout has since appealed the decision.
Other than his mental health issues, Nassim did not have any other conditions considered to be "significant illnesses," and his autopsy "reveals no evidence of other significant trauma or evidence of maltreatment."
Another Death, Another Autopsy Report
Truthout also obtained a copy of the autopsy report for another prisoner who died at Guantanamo, 48-year-old Afghan Awal Gul, who reportedly collapsed in a shower room late in the evening of February 1, 2011, three months before Nassim, after working out on a treadmill.
Gul "was exercising on a treadmill, and complained of being tired after 5 minutes. He went to shower where he collapsed," the autopsy report said.
Gul was found with his back to the shower wall, "foaming around the mouth."
"He was carried by other detainees to the cell block gate," the autopsy report said. Following unsuccessful attempts to revive him, Gul was transported to the naval hospital on the island and pronounced dead about an hour after he collapsed. The cause of death was attributed to atherosclerotic cardiovascular disease, or hardening of the arteries.
According to his autopsy report, Gul, who was 5'8" and weighed 220 pounds at the time of his death, had a medical history of obesity and "poorly controlled hypertension." He complained of chest pains a few days before his death, but lab tests did not reveal evidence of any loss of oxygen to his heart.
The autopsy report said Gul's chest pain was "reportedly associated with eating" raising the possibility it was the result of acid reflux, a condition Gul believed was responsible for chest pains he suffered for a two week stretch a year earlier.
Still, the medical examiner's review of Gul's medical records states that Gul was "in overall good health."
Gul, who was sent to Guantanamo in 2002, was accused of being a recruiter for al-Qaeda who ran a guest house for the terrorist organization and had met with Osama bin Laden several times. However, Matthew Dodge, Gul's habeas corpus attorney, told the Associated Press in 2011 that the US government's claims were "outlandish" and that the only reason Gul was indefinitely detained was because the US government did not have any evidence to support his prosecution.
Dr. Cyril Wecht, a world-renowned forensic pathologist who has performed more than 15,000 autopsies and consulted on 35,000 postmortem examinations, many of which were high-profile cases, reviewed the autopsy reports for Truthout. He said he does not disagree with the conclusions.
"They are both good, complete, detailed autopsies," Wecht told Truthout.
However, Wecht was critical that Gul was not placed under observation and monitored when he complained of "localized, squeezing chest pain in the center of his chest" on January 28, 2011. Guantanamo medical personnel conducted an Electrocardiogram (ECG) and performed other medical tests on Gul, the results of which were negative, according to the autopsy report.
Gul returned to his cell and was supposed to be seen again in a week. But he died four days later.
"The heart attack, I agree with [the medical examiner] based upon the microscopic characteristics that this had been present for about a week or so," Wecht said. "But quite frankly, in a medical malpractice setting, one could raise the question, 'Should they have hospitalized him? Should they have kept him under observation?' From a malpractice standpoint, I would be critical. I do believe this man should have been monitored because we know that myocardial infarction sometimes the enzyme studies and ECG studies are to be repeated. So I do not hesitate in expressing criticism of that."
According to the Encyclopedia of Heart Disease, when a patient shows signs of a possible heart attack, in about 5-10 percent of cases the test may show as non-diagnostic or normal. The ECG is repeated every 6 to 24 hours, and the patient may be admitted for 24-hour observation.
"A careful physician often repeats the ECG and blood test for troponin or [Creatine Kinase]," enzyme tests to monitor and detect heart attacks, "every two hours," the book states.
Standard Operating Procedures Not Enforced
In addition to the NCIS investigation into the deaths of Nassim, Gul and Latif, SOUTHCOM also conducted what's known as a commander's inquiry into the deaths of the prisoners. Those reports are complete and were recently shared with members of the House and Senate Armed Services Committees.
Navy Lt. Cmdr. Ron Flanders, a SOUTHCOM spokesman, said the reports on Nassim and Gul are still undergoing a declassification review. A redacted version will be released publicly but Flanders does not know when.
"The Latif report will come first, likely later this month," Flanders said. "Gul and Nassim's report will come afterwards."
The SOUTHCOM reports pertaining to Nassim and Latif determined that both men were successful in taking their own lives because some of the prison's SOPs were not being enforced, according to US officials who were briefed about the commander's inquiries.
Deviating from the SOP is considered to be an Article 92 violation - failure to obey an order or regulation - under the Uniform Code of Military Justice (UCMJ). US officials said they did not know if any JTF-GTMO personnel have been reprimanded for allegedly failing to follow the SOPs.
Last December, the American Civil Liberties Union (ACLU) criticized the Obama administration for continuing to conceal the autopsy reports of Nassim, Gul and Latif. The organization said, "Without public disclosure of these autopsy reports, the public has an incomplete understanding of what happened" to the men "while in U.S. custody."