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UNCLASSIFIED TOP SECRET////NOFORN * Cables and records indicating that CIA detainees who were undergoing or had undergone the CIA's enhanced interrogation techniques were subjected to rectal rehydration, without evidence of medical necessity, and that others were threatened with it; See 34491 (051400Z MAR 03); Interview of, by [REDACTED] and [REDACTED] of the Office of the Inspector General, March 27, 2003;  34575 ; email from: ; to: [REDACTED]; cc: ; subject: Re: Update; date: , at 4:51:32PM;  12385 (222045Z JUL 03); 10415. In addition to the rectal rehydration or feeding of al-Nashiri, KSM and Majid Khan, described elsewhere, there is at least one record of Abu Zubaydah receiving "rectal fluid resuscitation" for "partially refusing liquids." (See 10070 .) Marwan al-Jabhur was subjected to what was originally referred to in a cable as an "enema," but was later acknowledged to be rectal rehydration. (See 2563 ; email from: ; to:, [REDACTED], [REDACTED], [REDACTED], [REDACTED]; subject: Re: TASKING – Fw: date: March 30, 2007; DTS #2007-1502.) Ramzi bin al-Shibh, Khallad bin Attash and Aduan al-Libi were threatened with rectal rehydration. (See 10415 ; 12385 (222045Z JUL 03); email from: ; to: ; subject: Medical Evaluation/Update (047); date: March, 2004.) CIA medical officers discussed rectal rehydration as a means of behavior control. As one officer wrote, "[w]hile IV infusion is safe and effective, we were impressed with the ancillary effectiveness of rectal infusion on ending the water refusal in a similar case." (See email from: ; to: ; subject: Re: (048); date: February, 2004.) The same officer provided a description of the procedure, writing that "[r]egarding the rectal tube, if you place it and open up the IV tubing, the flow will self regulate, sloshing up the large intestines." Referencing the experience of the medical officer who subjected KSM to rectal rehydration, the officer wrote that, "[w]hat I infer is that you get a tube up as far as you can, then open the IV wide. No need to squeeze the bag – let gravity do the work." (See email from to, , , , and [REDACTED], February 27, 2004, Subject: Re:  (048).) The same email exchange included a description of a previous application of the technique, in which "we used the largest Ewal [sic] tube we had." (See email from: [REDACTED]; to: ; cc: [REDACTED],, [REDACTED], [REDACTED]; subject: Re: (048); date: February , 2004, at 11:42:16 PM.) As described in the context of the rectal feeding of al-Nashiri, Ensure was infused into al-Nashiri "in a forward-facing position (Trendlenberg) with head lower than torso." (See 1203 (231709Z MAY 04).) Majid Khan's "lunch tray," consisting of hummus, pasta with sauce, nuts, and raisins was "pureed" and rectally infused. (See 3240 (231839Z SEP 04).) The CIA's June 2013 Response does not address the use of rectal feeding with CIA detainees, but defends the use of rectal rehydration as a "well acknowledged medical technique." CIA leadership, including General Counsel Scott Muller and DDO James Pavitt, was also alerted to allegations that rectal exams were conducted with "excessive force" on two detainees at DETENTION SITE COBALT. CIA attorney was asked to follow up, although CIA records do not indicate any resolution of the inquiry. CIA records indicate that one of the detainees, Mustafa al-Hawsawi, was later diagnosed with chronic hemorrhoids, an anal fissure, and symptomatic rectal prolapse. See email from: [REDACTED]; to: [REDACTED]; cc:, , [REDACTED]; subject: ACTIONS from the GC Update this Morning, date: , at 12:15 PM; email from: ; to: [REDACTED]; cc: , [REDACTED], [REDACTED], [REDACTED], subject: ACTIONS from the GC Update this Morning; date: , at 1:23:31 PM; email from: ; to: [REDACTED]; cc: , [REDACTED]; subject: Re: ACTIONS from the GC Update this Morning REQUEST FOR STATUS UPDATE; date: December , 2003, at 10:47:32 AM; 3223 ; HEADQUARTERS. Page 100 of 499
 * Cables noting that groups of four or more interrogators, who required practical experience to acquire their CIA interrogation "certification," were allowed to apply the CIA's enhanced interrogation techniques as a group against a single detainee; and TOP SECRET////NOFORN

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