Hernán Reyes has been an ICRC doctor for 27 years. During this time, he has visited hundreds of prisons across five different continents. To read an older interview with Hernán about his time working in Uruguay in the 1980s, click here. 

What does health and detention mean? What does it entail?

Health and detention means everything that is good for health for people held in custody, and conversely, what is bad for health. This can entail everything from scabies and tuberculosis to torture and ill treatment. It includes issues related to solitary confinement and to ethical issues such as hunger strikes and the split duties of doctors who both work for prison administration officials and for their patients.

You mentioned medical ethics. This is an issue that has risen to some prominence in North American in recent years. Why is the ICRC concerned with medical ethics?

Doctors working in criminal justice system are often confronted with dilemmas of doing, or not doing, what the prison director tells them to do, which may go against medical ethics. For example, in some countries, doctors sit in on the commission that decides whether a prisoner is sent to a punishment cell. This should not be, as the doctors will lose the trust of their patient. Also, if the punishment cell is such that health problems may arise, then the system of punishment should be changed.

Now imagine a situation where the ICRC works, visiting security detainees, political prisoners, prisoners who might have been tortured, for example. Doctors in these environments are under even more pressure. They may be forced to feed people against their will, who are on hunger strike, or forced to patch people up knowing they have been tortured. There is a medical dilemma of dual loyalties. Is the doctor loyal to his or her job, to the police, army, or prison service? Or is the doctor loyal to the Hippocratic oath and to the patient?

Is there a consensus on the issue of these dual loyalties?

For the ICRC, a doctor is a doctor is a doctor. In the past, some people have tried to make a distinction between clinicians and the other doctors who could be involved in practices not necessarily good for people's health. A very clear example would be a doctor who helps devise interrogation procedures by exploiting what other doctors learn during medical consultations. That is not ethical at all, and this is not just the ICRC saying so, but rather it is the position of the highest medical authorities, such as the World Medical Association. Plenty of medical associations, for physicians and psychiatrists, have said that doctors should never participate in interrogation procedures, either actively, passively, or in an advisory capacity.

What brings you to the United States?

I received an invitation from a former chief medical officer at Guantanamo Bay Naval Station, with whom I worked personally in 2003. At that time, he and I had an open and frank dialogue on the subject of health and detention, of course within the ICRC's confidential way of working. Now, many years later, he asked me to address the U.S. Naval War College in Rhode Island on the specific issues of dual loyalties, health and detention, and hunger strikes from an ethical point of view.