DEATH
IN CAMP DELTA

Mark Denbeaux
Professor, Seton Hall University School of Law
Director, Seton Hall Law Center for Policy & Research
Counsel to Guantanamo detainees
Co-Authors & Research Fellows
Center for Policy & Research
Brian Beroth, Scott Buerkle, Sean Camoni, Meghan Chrisner,
Adam Deutsch, Jesse Dresser, Doug Eadie, Michell~ Fish,
Marissa Litwin, Michael McDonough, Michael Patterson,
Shannon Sterritt, Kelli Stout, Paul Taylor

EXECUTIVE SUMMARY
On the night of June 9, 2006, three detainees died in a maximum security section of the
Guantánamo Bay Detention facility. The military‘s initial press releases reported not only that
the detainees were found hanging in their cells but also that their actions were a conspiracy as
part of ―asymmetrical warfare" against the United States. At the same time, the military ordered
all media off the island and prevented all lawyers from visiting their clients.
Questions immediately arose about how three detainees, under constant supervision, were
able to conspire effectively to commit coordinated suicides. The military soon announced that it
was conducting an investigation, but the results were not published until more than two years
later. In August 2008 a heavily redacted report of the investigation concluded that the detainees
had hanged themselves in their cells and that one detainee, while walking the corridors that
night, had announced, ―tonight‘s the night.‖
The investigation, however, leaves many unanswered questions. Three years later it is
still unclear how such coordinated conduct could have occurred, much less how heavily
supervised detainees could have been dead for more than two hours before they were discovered.
Both the time and exact manner of the deaths remain uncertain, and the presence of rags stuffed
in the detainees‘ throats is unexplained. Negligence of the guards seems to have been ruled out
by the absence of any disciplinary action by any military personnel. Although some of the guards
were formally warned that their original statements were suspected to be false or that they were
suspected of failing to follow direct orders, no guard was ultimately charged with either making
a false statement or being derelict in his duty.
The following report examines the investigation, not to determine what happened that
night, but rather to assess why an investigation into three deaths could have failed to address
significant issues. Further, the report raises serious questions that must be addressed to dispose of
rumors that have circulated—rumors that the cause of the deaths was more sinister than
―asymmetrical warfare.‖
This report reveals the following facts:


The original military press releases did not report that the detainees had been dead for
more than two hours when they were discovered, nor that rigor mortis had set in by
the time of discovery.



There is no explanation of how three bodies could have hung in cells for at least two
hours while the cells were under constant supervision, both by video camera and by
guards continually walking the corridors guarding only 28 detainees.



There is no explanation of how each of the detainees, much less all three, could have
done the following: braided a noose by tearing up his sheets and/or clothing, made a
mannequin of himself so it would appear to the guards he was asleep in his cell, hung
sheets to block vision into the cell—a violation of Standard Operating Procedures,
tied his feet together, tied his hands together, hung the noose from the metal mesh of
ii

the cell wall and/or ceiling, climbed up on to the sink, put the noose around his neck
and released his weight to result in death by strangulation, hanged until dead and
hung for at least two hours completely unnoticed by guards.


There is no indication that the medics observed anything unusual on the cell block at
the time that the detainees were hanging dead in their cells.



The initial military press releases did not report that, when the detainees‘ bodies
arrived at the clinic, it was determined that each had a rag obstructing his throat.



There is no explanation of how the supposed acts of ―asymmetrical warfare‖ could
have been coordinated by the three detainees, who had been on the same cell block
fewer than 72 hours with occupied and unoccupied cells between them and under
constant supervision.



There is no explanation of why the Alpha Block guards were advised that they were
suspected of making false statements or failing to obey direct orders.



There is no explanation of why the guards were ordered not to provide sworn
statements about what happened that night.



There is no explanation of why the government seemed to be unable to determine
which guards were on duty that night in Alpha Block.



There is no explanation of why the guards who brought the bodies to the medics did
not tell the medics what had happened to cause the deaths and why the medics never
asked how the deaths had occurred.



There is no explanation of why no one was disciplined for acts or failures to act that
night.



There is no explanation of why the guards on duty in the cell block were not
systematically interviewed about the events of the night; why the medics who visited
the cell block before the hangings were not interviewed; or why the tower guards,
who had the responsibility and ability to observe all activity in the camp, were not
interviewed.

As these many unanswered questions suggest, the investigations were themselves
contrary, not only to best practices for investigations of serious matters, but also failed to
conform to minimum standards in several ways. These include:


Failure to review relevant information, most of which was easily available including
audio and video recordings which are systematically maintained; ―Pass-On‖ books
prepared by each shift to describe occurrences on the block for the next shift; the
Detainee Information Management System, which contains records of all activity for

iii

that night as the events occur; and Serious Incident Reports, which are the reports
used when there are suicide attempts.


Failure to investigate an alleged conspiracy among detainees to commit suicide,
despite the Naval Criminal Investigative Service‘s statement that on the night in
question another detainee—who did not later commit suicide—walked through the
cell block telling people, ―tonight‘s the night.‖ There is no indication of how this
could have happened given camp security rules or, if it had taken place, why security
was not tighter than usual as a result.



Failure to investigate all available material witnesses who would have had an
opportunity to observe what happened that night.

iv

Table of Contents
EXECUTIVE SUMMARY ........................................................................................................................................ ii
1. Introduction and Summary of Events and Military Investigations ....................................................................3
A. Summary of Events as Described by the Investigative File ..................................................................................4
B. Initial Inquiries by Colonel Bumgarner ................................................................................................................5
C. The Investigations .................................................................................................................................................5
D. The Staff Judge Advocate (SJA) Report ordered by Admiral Harris ....................................................................6
E. The Issue ...............................................................................................................................................................7
2. Methodology .............................................................................................................................................................7
3. Government Investigation.......................................................................................................................................8
A. NCIS Investigation ................................................................................................................................................9
B. CITF Report ........................................................................................................................................................ 10
C. SOUTHCOM ...................................................................................................................................................... 11
D. The SJA Report ................................................................................................................................................... 11
4. Operation of Camp Delta ...................................................................................................................................... 12
A. Detained in Maximum Security Facility ............................................................................................................. 13
B. Standard Operating Procedures ......................................................................................................................... 14
1. Chain of Command ......................................................................................................................................... 14
2. Constant Supervision ...................................................................................................................................... 15
3. Security Response Force ................................................................................................................................. 16
4. SOP Compliance Mandatory at All Times ...................................................................................................... 17
5. The Deaths .............................................................................................................................................................. 17
A. What the Detainees had to do to Commit Suicide by Hanging ........................................................................... 18
B. Description of the Corpses.................................................................................................................................. 19
C. Autopsies............................................................................................................................................................. 20
D. Estimated Time of Death .................................................................................................................................... 21
1. Dried Abrasion Furrow ................................................................................................................................... 21
2. Rigor Mortis .................................................................................................................................................... 22
3. Body Temperature .......................................................................................................................................... 22
4. Hang Time ...................................................................................................................................................... 22
5. Summary ......................................................................................................................................................... 23
6. June 9 and 10, 2006................................................................................................................................................ 23
A. Climate of the Camp ........................................................................................................................................... 24
B. Emergency Procedures ....................................................................................................................................... 25

1

C. Actions of the Guards, Medics, and Detainees Prior to Discovery of the Bodies............................................... 25
D. Discovery of the Bodies According Guard Statements ....................................................................................... 28
1. Medical Response for Al Zahrani ................................................................................................................... 31
2. Medical Response for Al Tabi and Ahmed ..................................................................................................... 33
3. Aftermath ........................................................................................................................................................ 33
E. Pre-Investigation Intervention ............................................................................................................................ 34
F. Colonel Bumgarner‟s and Admiral Harris‟ Statements ...................................................................................... 35
G. Silence ................................................................................................................................................................ 38
1. Silence of the Medics ...................................................................................................................................... 38
2. Silence of the Commander .............................................................................................................................. 39
3. Silence of the Detainees .................................................................................................................................. 39
7. Failures of the Investigations ................................................................................................................................ 41
A. Evidence Without Findings, Findings Without Evidence .................................................................................... 41
1. Evidence Without Findings ............................................................................................................................. 41
2. Findings Unsupported by Evidence ................................................................................................................ 41
B. Defective Interviews ............................................................................................................................................ 44
1. Tainted Interviews: Commanding Officer ..................................................................................................... 44
2. Investigating Officers Unable to Identify Those Responsible for the Detainees‘ Ability to Commit Suicide
............................................................................................................................................................................ 45
3. Superficial Guard Interviews .......................................................................................................................... 45
4. Unasked Questions.......................................................................................................................................... 46
5. Interrupted Investigation: Afternoon of June 10 to June 14 ............................................................................ 46
6. Questionable Framing of the Interviews and Statements ................................................................................ 47
C. False Statements ................................................................................................................................................ 47
D. Missing Evidence ................................................................................................................................................ 49
1. Missing Sworn Statements .............................................................................................................................. 49
2. Missing Surveillance Video and Audio Recordings ....................................................................................... 50
3. Missing Duty Roster, Detainee Transfer Book, and Pass-on Book ................................................................ 50
4. Missing Witnesses .......................................................................................................................................... 51
5. Missing Serious Incident Reports ................................................................................................................... 52
E. Impenetrable Presentation .................................................................................................................................. 52
F. No Disciplinary Action Recommended Despite SOP Violations ......................................................................... 53
CONCLUSION .......................................................................................................................................................... 54

2

1. Introduction and Summary of Events and Military Investigations
On June 9, 2006, three detainees died while in custody at Camp 1 of the Guantánamo Bay
detention facility. Yassar Talal Al Zahrani, Mani Shaman Turki Al Habardi Al Tabi, and Ali
Abdullah Ahmed were each reported to have been found hanging in his cell at approximately
00:20 on June 10. The military conducted several investigations in the aftermath of the incident,
producing thousands of pages of material and finally releasing approximately 1,700 pages to the
public in August 2008 and April 2009. Despite months of investigation and multiple interviews
with guards, medical personnel, and commanding officers, the government does not answer the
question of how the detainees could have committed suicide in such a closely guarded, highsecurity facility.
The military and government reacted swiftly to the deaths. Shortly after Joint Task Force
Guantánamo (―JTF-GTMO‖) announced the deaths, the Commander of the Guantánamo Naval
Forces, Rear Admiral Harry Harris stated, ―I believe this was not an act of desperation, but rather
an act of asymmetrical warfare waged against us.‖1 Deputy Assistant Secretary of State Colleen
Graffy described the deaths as a ―good PR move to draw attention‖ and nothing more than ―a
tactic to further the jihadi cause.‖2 Both Harris and Graffy made these statements prior to the
completion of any investigation.
Before the last detainee was declared dead, investigators from the Naval Criminal
Investigation Service (―NCIS‖) began interviewing military personnel who ―had any dealings
with the response and treatment of the three [dead] detainees.‖3 Investigative action continued
for several months, but it took more than two years for NCIS to release its findings concluding
that the detainees killed themselves by hanging in their cells.
Six weeks after the June 9 deaths, Admiral Harris initiated an investigation into the
possible failure of Naval personnel to follow the Standard Operating Procedures (―SOPs‖) and
how such failures may have related to the detainees‘ deaths. Admiral Harris‘ report, released
publicly in April 2009, found that SOPs were violated and recommended that no disciplinary
action be taken. How Admiral Harris reached such conclusions is confusing as the autopsy
reports indicate that the detainees were hanging in their cells for at least two hours before guards
noticed them that night.

1

See ―Admiral: Gitmo suicides a ‗planned event,‘‖ CNN News, June 11, 2006,
http://www.cnn.com/2006/WORLD/americas/06/10/guantanamo.suicides/index.html?iref=newssearch; see also
―DoD Identifies Guantánamo Detainee Suicides,‖ June 12, 2006, U.S. Department of Defense, DefenseLINK,
http://www.defenselink.mil/news/newsarticle.aspx?id=16072.
2
See ―Guantánamo suicides a ‗PR move,‘‖ BBC News, June 11, 2006,
http://news.bbc.co.uk/2/hi/americas/5069230.stm.
3
See Naval Criminal Investigative Service, Report of Investigation, 2,
http://www.dod.mil/pubs/foi/detainees/death_investigation/NCIS_DeathInvestigativeFiles.pdf [hereinafter NCIS].

3

A. Summary of Events as Described by the Investigative File
On the night of the deaths, Alpha Block was monitored by guards and videos cameras.
Guards observed the detainees at least every 10 minutes while walking the tier. Cells on Alpha
Block have one solid wall and three metal mesh sides so that guards on the block, and tower
guards outside, are able to see into the cells. The five Alpha Block guards monitored 28
detainees. The three detainees in question were in cells located on the same side of Alpha Block.
At least three of the cells in between them were empty.
Accepting the military investigation findings as true and complete, in order to commit
suicide by hanging, the detainees must have:










Braided a noose by tearing up their sheets and/or clothing
Made mannequins of themselves so it would appear to the guards that they were
asleep in their cells
Hung sheets to block the view into the cells, a violation of SOPs
Tied their feet together
Tied their hands together
Shoved rags in their mouths and down their throats
Hung the noose from the metal mesh of the cell wall and/or ceiling
Climbed up on to the sink, put the noose around their necks and released their weight,
resulting in death by strangulation
Hung dead for at least two hours completely unnoticed by guards

SOPs required guards to note movement or to see the detainee‘s skin while walking the
block. This raises many questions as to how three detainees on the same cell block, on the same
side of the block, were able to complete the aforementioned acts without any Alpha guards
noticing.
Al Zahrani was reportedly discovered hanging in his cell after midnight on June 10. Upon
discovery, the Alpha guards did not call the medics to assist, nor did they advise the medical
clinic or call for escort guards or any kind of assistance, as required by SOPs. Instead, all five
Alpha guards transported Al Zahrani to the medical clinic approximately 100 yards away.
According to the autopsy reports, it took about 28 minutes to do so, leaving the cell block
completely unguarded while two other detainees hung in their cells. The Alpha guards did not
notice two other detainees hanging dead in their cells.
The Alpha guards who brought Al Zahrani to the clinic reported that the doors of the
clinic were closed, and they had to knock repeatedly until they were finally admitted. No doctor
was on duty that evening, so clinic personnel had to call a doctor to properly attend to the
detainee. When they were unable to locate the doctor‘s telephone number, clinic personnel had to
call 911 for medical assistance. During this time the Alpha guards did not explain to the clinic
personnel what had happened to the detainee or how he was found, nor did the clinic personnel
ask the guards what had happened. Other guards from around the camp who happened to be on
or around Alpha block discovered the second hanging detainee. Al Tabi was found in his cell and
4

brought to the clinic about 10 minutes after Al Zahrani. Minutes later, other guards discovered
Ahmed hanging in his cell and brought him to the clinic.
The medics began resuscitation attempts on each detainee after his arrival. According to
descriptions from the guards, medics, and autopsy reports, all three detainees were cold to the
touch, bluish in color, and in a state of rigor mortis, indicating that each had been dead for more
than two hours at the time of discovery. Their eyes were rolled back in their sockets and they had
no pulse. Rigor mortis locked their jaws and impeded resuscitation attempts. In the case of one
detainee, his jaw had to be pried open with a metal instrument that broke his teeth. At that time,
medical personnel discovered that he had a cloth deep in his mouth and down his throat. The
same condition was discovered in the other two bodies. The investigations did not explain why
the detainees had rags in their throats.
Al Zahrani was subsequently transported to the hospital where he was declared dead at
01:50. Al Tabi and Ahmed were declared dead at the clinic at 01:15 and 01:16, respectively.
Immediately after the detainees were declared dead, Admiral Harris arrived at the clinic and
praised the medical staff and the guards for the manner in which they had performed, stating that
they could not have done anything more to save the detainees.

B. Initial Inquiries by Colonel Bumgarner
On June 10, 2006, Colonel Michael Bumgarner (―Commander‖), the commanding officer
responsible for the guards at Camp Delta initiated the first investigation into the night‘s events.
The Commander initially ordered the guards to write sworn statements of what had occurred that
night. After they started to do so, however, he countermanded his own order and no statements
were ever produced.
All of the witnesses were brought into the conference room to await individual interviews
by the commanding officer. The Commander told them to sign their names and to indicate with
an asterisk next to their signatures if they had been assigned to Alpha Block. During these
interviews, all other witnesses were told to remain in the conference room without talking. The
Commander interviewed some of the Alpha guards to discover what happened. He did not take
notes or record any names, and subsequently did not remember with whom he had met.
Those interviewed privately by the Commander joined the other witnesses in the
conference room to await interviews with NCIS and the Criminal Investigation Task Force
(CITF), which began about two hours later. The investigative file contains only brief summaries
of these interviews, which were conducted by local NCIS and CITF and appear to be the only
interviews conducted before the NCIS investigative team arrived from Miami at about 15:30 that
afternoon.

C. The Investigations
From the afternoon of June 10 to the morning of June 14, there is no evidence of any
NCIS or CITF interviews. When the investigations resumed, investigators notified each of the
Alpha Block guards that he was suspected of having made false statements or failing to obey
direct orders. The NCIS and CITF investigative documents do not indicate what allegedly false
5

statements were, when they were made, or what direct order was disobeyed. The only record of
any previous statements made by the Alpha guards was the unrecorded statement taken by the
commanding officer in his office early on the morning of June 10 before the NCIS investigation
began.
The NCIS and CITF investigators interviewed guards, medics, detainees, and the
commanding officer between June 14 and June 20, 2006. The next reported interview was not
until 21 days later on July 11, 2006. It is possible that additional information and interviews are
contained in the more than 600 missing and completely redacted pages in the combined
investigative file. Nevertheless, there is no record of any investigatory body reviewing direct
evidence from Camp Delta or Alpha Block from June 9-10, 2006.
The investigations apparently did not review videotapes of the cell block, ―pass-on‖
books, the duty roster for Alpha Block that night, audio recordings, records of detainee transfers
from Alpha Block, or medical records from the detainee clinic that night. Furthermore, the
investigation did not review records from the tower guards—who would have had a clear view of
cell block, records of the camp communication center, or Block Documentation Detainee
Information Management Systems (―DIMS‖) records of all computer communications between
all cell blocks and the Command Center.4
The investigative reports did not determine which Alpha guards were assigned to the
block, what the Alpha guard shift schedule was for that night, and which Alpha guard was
responsible for carrying out specific SOPs that night, including cell checks and headcounts. The
investigations also failed to determine what the guards who were in a position to observe and/or
prevent the deaths saw or did not see. Various guards and a platoon leader were documented as
walking the block from 21:30 to 23:47, but according to the investigation there were no
determinations made about what they saw. Finally, no investigation recognized or addressed the
fact that the detainees had been dead for hours before they were discovered or the presence of
cloth lodged in the mouths and deep down the throats of all three detainees.

D. The Staff Judge Advocate (SJA) Report ordered by Admiral
Harris
The NCIS investigation was not tasked with recommending disciplinary proceedings for
violations of the SOPs that might have contributed to the deaths. Instead, Admiral Harris
appointed an Investigating Officer at least one month after the detainee‘s deaths to determine
whether there had been any SOPs violations on June 9-10, and if so, whether those violations
contributed to the ability of the detainees to commit suicide.
Admiral Harris concluded no disciplinary action was necessary. He stated that even if all
SOPs had been followed, it was possible that the detainees still could have committed suicide.
Additionally, there was confusion among the guards regarding the SOPs.

4

NCIS did attempt to retrieve the 911 logs from June 9-10, 2006; however, the system had a power failure and was
not properly reactivated. The system was not in operation from May 3, 2006 until June 10, 2006. NCIS at 926.

6

E. The Issue
Three men died, and there is little to no explanation of how this could have occurred in a
maximum security facility. The investigations do not clarify what occurred that night, nor do
they answer basic questions: who, what, where, when, why, and how Al Zahrani, Al Tabi, and
Ahmed died.
After NCIS released its initial summary, news media, academics, and other critics
questioned the events of that night.5 Based on the facts presented in the released documents, a
number of questions remain about the events of June 9 and 10.
There is no indication in any of the interviews or statements of any suspicious activity on
Alpha Block before the discovery of the bodies. As the Commander himself noted, in past
suicide attempts other detainees made it ―urgently and loudly known that a detainee was carrying
out some type of self-harm.‖6 No cries were heard from the detainees, and aside from chanting
earlier in the day, no other unusual activity was noted that might indicate a suicide attempt. None
of the guards or medics on the floor that night noticed any of the detainees hanging dead,
although the detainees were hanging for more than two hours before discovery.
The report that follows maps the events of that night as described in statements made in
the investigative files and explains the relevant SOP regulations governing the personnel on duty.
In doing so, the report documents that the guards who were on duty, other military personnel,
and various detainees all made statements that create inconsistencies and questions. This report
makes no conclusions regarding what actually transpired on June 9 and 10, 2006.

2. Methodology
The Center for Policy and Research began investigating the government response to the
June 10 deaths days after the incident in 2006. On August 21, 2006, the Center published, ―June
10th Suicides at Guantánamo: Government Words and Deeds Compared.‖7 This report profiled
the three detainees who committed suicide—Ahmed, Al Zahrani, and Al Tabi—and found that
critical information was withheld from the detainees at the time of their deaths.8

5

See Father of Gitmo Suicide Victim Blames U.S., MSNBC, June 14, 2006, available at
http://www.msnbc.msn.com/id/13300107; Andy Worthington, Guantanamo Suicide Report: Truth or Travesty?, THE
HUFFINGTON POST, Aug. 25, 2008, available at http://www.huffingtonpost.com/andy-worthington/guantanamosuicide-report_b_121358.html; Anger at US response to suicides, BBC NEWS, June 12, 2006, available at
http://news.bbc.co.uk/2/hi/uk_news/5070574.stm; Josh White, How three Guantanamo Bay prisoners killed
themselves under guards' noses, STAR TRIBUNE, Aug. 30, 2008, available at
http://www.startribune.com/nation/27674259.html?elr=KArksLckD8EQDUoaEyqyP4O:DW3ckUiD3aPc:_Yyc:aU
UJ.
6
See NCIS at 1063.
7
Mark Denbeaux, et al, June 10th Suicides at Guantánamo: Government Words and Deeds Compared (2006),
available at http://law.shu.edu/publications/guantanamoReports/guantanamo_report_june_suicides_8_21_06.pdf.
8
See id.

7

Approximately two and a half years after the incident on August 22, 2008, the
Department of Defense (―DOD‖) released its official findings statement. Admiral Harris‘s report
was released the next April. In all, the investigative documents contain more than 1,700 pages.
This report relies primarily upon those documents prepared and released by the United
States Government after the June 10, 2006, incident, but also includes public statements of
certain high-ranking individuals and official press releases. Some of the documents were
released to the public through the Freedom of Information Act (―FOIA‖); others the Department
of Justice (―DOJ‖) and the DOD released voluntarily. Some were leaked. It was not until all of
these independent sources were painstakingly compiled that the picture began to take form.
In developing and writing this report, the research fellows at Seton Hall University
School of Law‘s Center for Policy and Research reviewed and analyzed the investigative files of
the June 10, 2006, deaths released by the DOD. These files include reports from the Naval
Criminal Investigation Service (―NCIS‖), the Criminal Investigation Task Force (―CITF‖), US
Southern Command (―SOUTHCOM‖), the Staff Judge Advocate‘s Report (―SJA Report‖), and
the Armed Forces Medical Examiner‘s autopsies of the three men. This report accepts as true all
of the information released by the government to the extent that the information is not internally
inconsistent.
Since all documents are heavily redacted—names, dates, and other facts are on most
pages completely obscured—the Center Research Fellows worked more than six months to
deconstruct the investigation, synthesize the information, and construct the events of June 9 and
10. In developing this report, the Center examined the government‘s investigative findings by
combining separate investigative files using the handwritten page numbers. Then, each interview
summary or statement was identified. The names of the interviewees are redacted from the
documents, so each interview was labeled and categorized by the date, type of personnel, and
contents therein.9
This report provides an in-depth look at the SOPs of Camp Delta in the Guantánamo Bay
Detention Facility.10 It then scrutinizes the deaths of the detainees and the subsequent autopsies.
Next, the report analyzes the findings of the investigations. Finally, it points out the defects in
the investigation.

3. Government Investigation
The investigations of the June 10, 2006, deaths at Camp Delta came to similar
conclusions concerning the detainees‘ deaths. Each investigation conducted its own interviews
but relied on findings from the other investigative files in making its own conclusions.11 The
investigative documents are organized with handwritten page numbers; where page numbers are
missing from one investigative document, they are found in another investigative document or

9

See Appendix A for a list of interviews for each personnel.
The SOPs used in the report are the 2004 Standard Operating Procedures, the latest publicly available edition. The
2005 SOPs were adopted in March of that year and were in place at the time of the suicides.
11
See Table 1, Appendix A for a list of those interviewed and the dates of the interviews.
10

8

are redacted entirely. While each investigation began in 2006, the first findings were not released
until August 2008, more than two years after the incident. The investigations concluded that the
detainees committed suicide in a coordinated act of asymmetrical warfare against the guards in
the facility.

A. NCIS Investigation
NCIS is the ―primary law enforcement and counterintelligence arm of the United States
Department of the Navy.‖12 NCIS has three main strategic objectives: to prevent terrorism,
protect secrets, and reduce crime.13 In its efforts to prevent terrorism, NCIS is responsible for
conducting ―suspicious incident investigations and operations aimed at detecting, deterring and
disrupting terrorist activities against the Department of the Navy personnel and assets
worldwide.‖14 In an attempt to reduce crime, NCIS provides criminal investigations of all major
criminal offenses punishable under the Uniform Code of Military Justice that occur within the
Department of the Navy.15
__________________________________________________
“This is a reactive investigation initiated to determine cause
and manner of death…”16
- NCIS Investigative File
__________________________________________________

On June 10, 2006, NCIS initiated an investigation into the deaths of detainees Al Zahrani
(ISN 093), Al Tabi (ISN 588), and Ahmed (ISN 693).17 After all three bodies were removed and
the death scenes secured, NCIS arrived at Camp 1 to begin its investigation.18 NCIS conducted
interviews with specific personnel involved in the response and treatment of the three
detainees.19 Those interviewed include the Alpha guards, the officers on duty, escort control,
guards from other cell blocks, and medical personnel at the Detention (―DET‖) Clinic.20 NCIS
officials interviewed 16 detainees assigned to Alpha Block; however, it reported that the
detainees did not provide any substantive information.21 The NCIS investigative file included
information from the Armed Forces Institute of Pathology, the institution that performed
autopsies on the three detainees.22 NCIS accepted the conclusion from the autopsies that the
cause of death for all three victims was hanging, but NCIS fails to address the findings of the
autopsies that the bodies had been dead for more than two hours. In addition, the U.S. Army

12

NCIS, http://www.ncis.navy.mil/mission/crime.asp.
NCIS, http://www.ncis.navy.mil/mission/crime.asp.
14
NCIS, http://www.ncis.navy.mil/mission/terrorism/counterterr.asp.
15
NCIS, http://www.ncis.navy.mil/mission/terrorism/counterterr.asp.
16
NCIS at 62.
17
NCIS at b.
18
NCIS at b.
19
NCIS at b.
20
NCIS at b.
21
NCIS at b.
22
NCIS at b.
13

9

Criminal Investigation Laboratory (―USACIL‖) revealed that Ahmed‘s and Al Zahrani‘s
fingerprints were on apparent suicide notes discovered on the bodies.23
During the on-site investigations, all paper documents were removed from all detainee
cells in the camp. NCIS subsequently established a Filter Litigation Team (―FLT‖) to review the
seized documents, both to determine whether they were relevant to the investigation and to
identify attorney-client privileged information.24 The FLT determined that twelve of the seized
documents were relevant to the investigation, none of which were cited in the conclusions of any
of the investigations.25
On May 12, 2008, the investigation was closed.26 NCIS issued a press release on August
22, 2008. Its preliminary findings concluded that the three detainees committed suicide by
hanging from ―braided rope made from bed sheets and tee shirts.‖27 They were found inside their
cells on Alpha Block of Camp Delta around 00:30 on June 10, 2006, and taken to the DET
Clinic.28 The detainees were last seen alive at 22:00 that night.29 Afterwards, Al Zahrani was
transported by ambulance to the Naval Hospital.30 He was pronounced dead at the Naval
Hospital, while Al Tabi and Ahmed were both pronounced dead at the DET Clinic.31 The only
evidence of a conspiracy is the statement that ―representatives of other law enforcement
agencies‖ reported that on the night of the hangings a detainee had ―walked through the cell
block telling people ‗tonight‘s the night.‘‖32 On each body, medical personnel found a short
written statement indicating the detainees coordinated the effort to rebel against their detainment
as martyrs.33 Lengthier statements were also found in each of their cells.34

B. CITF Report
CITF was established in 2002 by the Department of Defense to conduct investigations of
detainees captured in the war on terrorism.35 The organization investigates and builds criminal
cases against accused terrorists.36 CITF is comprised of a Joint Task Force made up of members
from the Army Criminal Investigation Division (―CID‖), NCIS, and the Air Force Office of

23

NCIS at b.
NCIS at b.
25
NCIS at 26; see also NCIS at b–c.
26
NCIS at c.
27
NCIS Statement of Findings from Suicide Investigation, 1, available at
http://www.dod.mil/pubs/foi/detainees/NCISStatement_Suicide_Investigation.pdf [hereinafter NCIS Statement].
28
NCIS Statement at 1.
29
NCIS Statement at 1.
30
NCIS Statement at 1.
31
NCIS Statement at 1.
32
NCIS Summary at 1-2.
33
NCIS Statement at 1.
34
NCIS Statement at 1.
35
Powlen, Jim, Criminal Investigation Task Force, MILITARY POLICE, March 22, 2007 at 1, available at
http://www.wood.army.mil/mpbulletin/pdfs/Spring%2007%20pdfs/Powlen.pdf. [hereinafter Powlen 2007].
36
Powlen 2007.
24

10

Special Investigations (―OSI‖).37 The headquarters for CITF is located in Virginia, but ―forwarddeployed detachments [are located] in Guantánamo Bay, Cuba; Iraq; and Afghanistan.‖38
The CITF documents are comprised of various interviews with Alpha Block guards, three
guards from other blocks who responded to the scene, various medical staff, and six detainees. In
addition, the report includes earlier interviews with Ahmed before his death. For example, one
document shows an interview dated September 18, 2003, where Ahmed claimed to be innocent
and in detention at Guantánamo by mistake.39 Furthermore, roughly half of the CITF pages are
redacted completely, and a review of the documents therein reveals neither a final conclusion nor
a set of findings. CITF made no official conclusions regarding its investigation.

C. SOUTHCOM
Located in Miami, Florida, SOUTHCOM is one of the Combatant Commands in the
Department of Defense that provides ―contingency planning, operations, and security
cooperation‖ for Cuba.40 As the umbrella unit for JTF-GTMO, SOUTHCOM was involved in
investigation of the three June 10, 2006 deaths.41
The SOUTHCOM investigative file contains a series of documents that supplement the
NCIS and CITF investigative files. Specifically, the SOUTHCOM file includes information
regarding the documents confiscated from detainees‘ cells and copies of the suicide notes and
uncertified translations.42 The file contains no conclusions regarding the information collected
and examined during its involvement with the investigation.

D. The SJA Report
The SJA Report is the result of an ―informal investigation‖ conducted by Admiral Harris,
Commander of the Guantánamo Naval Forces. On July 20, 2006, Admiral Harris appointed an
Investigating Officer to look into the June 10, 2006, deaths of the three detainees.43 The
investigation focused on whether there were any specific SOP violations on June 9-10, 2006, and
if so, whether the violations contributed to the ability of the detainee‘s to commit suicide.44
37

Powlen 2007.
Powlen 2007.
39
Criminal Investigation Task Force, Report of Investigative Activity, 92, available at
http://www.dod.mil/pubs/foi/detainees/death_investigation/Dickstein_CITF_docs.pdf [hereinafter CITF].
40
United States Southern Command, http://www.southcom.mil/AppsSC/pages/about.php.
41
United States Southern Command, http://www.southcom.mil/AppsSC/pages/about.php. See Joint Task Force
Guantanamo, http://www.jtfgtmo.southcom.mil. (―JTF Guantanamo conducts safe, humane, legal and transparent
care and custody of detainees, including those convicted by military commission and those ordered released. We
conduct intelligence collection, analysis and dissemination for the protection of detainees and personnel working in
JTF Guantanamo facilities and in support of the Global War on Terror. We provide support to the Office of Military
Commissions and support law enforcement and war crimes investigations.‖)
42
See e.g. US Southern Command 478-523, 609-48, 665-63, 664-672 [hereinafter SOUTHCOM].
43
Staff Judge Advocate, Investigation initiated by Admiral Harris, 149, available at
http://www.dod.mil/pubs/foi/detainees/death_investigation/DicksteinGTMO_SJA_DeathInvestigation.pdf.
[hereinafter SJA].
44
SJA at 4.
38

11

Specifically, he ordered the inquiry into two questions that NCIS was not investigating: (1)
whether the Camp Delta SOPs were followed by relevant Joint Detention Group (―JDG‖)
personnel during the overnight hours of June 9-10, 2006; and (2) if the SOPs were not followed,
whether that failure contributed to the ability of any of the three detainees to commit suicide on
that night. The investigation was completed, and the report was sent to the DOD on September 6,
2006.
In his final endorsement of the investigation, Admiral Harris accepted three of the
Investigating Officer‘s conclusions and rejected two of the Investigating Officer‘s conclusions.
The findings of the Harris report revealed that there were six SOP violations; the exact SOPs that
were violated are redacted from the file.45 The Admiral concluded that the SOP violations were
―not insignificant‖ and the proper JDG procedures should be followed to ensure accountability in
the future.46 The Admiral accepted that the SOP violations regarding guard coverage may have
contributed to the detainees‘ ―preparation of their suicides.‖47 The Admiral did not rule out that
the SOP violation regarding head counts contributed to the ―ability of the detainees to commit
suicide.‖ Admiral Harris further accepted that other SOP violations ―potentially contributed to
the ability of the detainees to commit suicide; however…it is possible…the detainees could have
successfully committed suicide regardless.‖48
Despite the SOP violations, Admiral Harris concluded that disciplinary action was not
warranted. Specifically, he determined that the ―permissive environment that persisted within the
JDG prior to the suicides‖ as well as the JDG leadership‘s ―apparent failure‖ to address guards‘
concerns, created circumstances that did not make disciplinary action necessary. 49

4. Operation of Camp Delta
The Guantánamo Bay Detention Facility is located on the southern coast of Cuba, inside
the Guantánamo Bay Naval Base. Sitting on the shore of the eastern tip of Guantánamo Bay
approximately four miles to the east of the naval airfield is Camp Delta, one of three known
camps that make up the detention facility.50
To ensure total supervision and control of the detainees, Guantánamo Camp Delta is
governed by SOPs that are established by the Department of Defense. These guidelines provide
―policy, procedures, and responsibilities for the security, administration, and treatment of
detainees in custody at Camp Delta.‖51
In addition to physical security measures at the camp, the SOPs create an extremely
secure environment where detainees are extensively monitored from the moment they arrive at
the Camp. Camp guards are instructed to maintain ―continuous presence on the blocks‖ by
45

SJA at 1–2.
SJA at 2.
47
SJA at 1.
48
See Appendix D.
49
SJA at 2.
50
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
51
SOP 1-1 (a) (2004).
46

12

frequently conducting headcounts, cell searches and various other security measures. 52 Below is
a more detailed description of Camp Delta‘s layout and the specific SOPs governing the guards‘
conduct.

A. Detained in Maximum Security Facility
Camp Delta contains four smaller camps, numbered 1 through 4, and the DET Clinic.53
Camp 1 sits between Camp 2 to the west and Camp 4 to the east.54 Camp 1 is connected to the
detainee hospital to the east by a small service road that enters through the main gates of Camp
1.55 Camp 1 faces outward toward the Caribbean Sea and, at its closest point, is less than 400 feet
from the water.56 Each Camp is separately enclosed and surrounded by barbed wire fence.57 A
sally port is located at the entrance of each Camp, where armed guards maintain access into and
out of the camp according to specific procedures.58 Sally Ports 4 and 6 control entrance to Camp
1.59
Camp 1 consists of ten cell blocks labeled A through J.60 Each block contains 48 cells
which are lined up into two rows that face each other along a corridor known as the tier.61 The
cells are entirely visible from the tier and are enclosed with mesh metal.62
Within Camp 1, Alpha Block is a maximum security facility that houses detainees who
have been placed in segregation for either behavioral reasons or for intelligence purposes. 63
Alpha Block is situated between Juliet Block and Bravo Block and is adjacent to Foxtrot Block.64
Sally Port 4 has unobstructed views of the entire Alpha Block.65
Alpha Block contains individual cells for each detainee.66 Each cell is approximately six
feet, eight inches by eight feet and consists of a sink, toilet, and cot for sleeping.67 On the door of
each cell is a ―bean hole,‖ which is a small window-like opening where the block guards deliver

52

SOP 6-1 (a) (2004).
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
54
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
55
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
56
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
57
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
58
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
59
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
60
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B. See also SOP at 6-11 (2004). (The
Detention Facility and personnel refer to each block using the NATO Phonetic Alphabet, thus A Block becomes
Alpha Block, B becomes Bravo, C becomes Charlie, and so forth).
61
SOP 2-2 (2004).
62
See Appendix C for pictures of the cells.
63
SOP 2-2(c) (2004).
64
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
65
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
66
SOP 2-2 (2004).
67
See Appendix C.
53

13

meals to the detainees and perform shackling and medical checks.68 In the rear of each cell is a
small window allowing for some natural light.69
Camp 1 in Guantánamo is a secure facility under constant surveillance. In addition to the
guards who patrol the cell blocks, there are several other security measures in place designed to
ensure that the camp is watched at all times. Camp 1 has six guard towers posted around its
perimeter.70 The guard towers look directly onto the cells of each of the blocks and monitor any
and all movement throughout the camps.71 The Sally Ports regulate access to all persons entering
or exiting the camp and are each staffed by one guard.
Entrance to Camp Delta is made through the Detention Operations Center (―DOC‖), the
headquarters of the camp. The DOC oversees all detention and security operations. ―It is from
here that all detainee movements are directed, controlled, and accounted for; that all keys are
controlled and accounted for; where entry and exit of all detainees are accounted for and where
emergency equipment is stored.‖72 The DOC regulates visitation and limits access to the facility
to persons with a valid reason.73 Every aspect of Camp Delta is under the complete control of the
DOC and guard personnel.

B. Standard Operating Procedures
The SOPs are the guidelines for all camp personnel in carrying out daily activities. Camp
personnel are not only required to follow these procedures but also to ―sign a statement of
understanding/acknowledgement that they have read and will adhere to all SOP provisions for
Camp Delta.‖74
1. Chain of Command
The SOPs delineate the chain of command for the camp, headed by the Commander of
the Joint Detention Operations Group (―CJDOG‖) who has overall responsibility for the Camp.
The on-duty Commanding Officer (―CO‖) is in charge of Camp Delta and reports to the
CJDOG.75 The CO is responsible for the day-to-day care, custody, control, discipline, safety, and
welfare of all detainees.76 In addition, the CO is responsible for the conduct and discipline of the
guard force personnel.77

68

SOP 6-6 (2004).
SOP 6-26 (2004).
70
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
71
SOP at Appendix D.1 (2003). See Maps of Camp Delta, Appendix B.
72
SOP 2-7 (a) (2004).
73
SOP 2-7 (c) (2004).
74
SOP at 1-1 (e) (2004).
75
SOP at 2-4 (c) (2004).
76
SOP at 2-4 (c) (2004).
77
SOP at 2-4 (c) (2004).
69

14

There are two Platoon Leaders (―PLs‖) on duty for each shift, who report to the CO and
assist in the day-to-day operation of the camp.78 Below the PLs are the Sergeants of the Guard
(―SOGs‖).79
The SOGs are responsible for the care, conduct, and safety of the
guard force. They enforce accountability, control, safety, care, and
humane treatment of detainees; ensure that all personnel perform
their assigned duties and tasks to standard and adhere to the Camp
Delta SOP[s.]80
During each shift, a Block Non-Commissioned Officer (―NCO‖) is assigned to each
block and reports to the SOG for his or her respective camp. The Block NCO ―supervises all
guards assigned to the block and is responsible for all aspects of custody and control, care,
shelter, feeding, and treatment of all detainees housed in the cell block.‖81
In addition to the line of command dealing with actual detention, the Escort Control
personnel are responsible for the movement of detainees and personnel throughout the camp.82
The Escort Control NCO reports directly to the DOC.83
2. Constant Supervision
All detainee movement is highly secure. Whenever a detainee is removed from his cell,
the SOPs require that he wear three-piece restraints to prevent escape as well as self-injury.84 In
addition to the restraints, the detainee is accompanied by a team of escorts whenever he is moved
outside the cell.85 Each time a detainee is moved, the Escort Guards must go through an
extensive checklist.86 This checklist includes notifying all relevant officers and personnel
involved, logging the start and stop times of detainee movement, and securing the detainee once
he has been escorted to his destination.87 Furthermore, there are differing sets of procedures
depending on whether the detainee is being moved for intelligence reasons or medical reasons. 88
The purpose of this is to ensure that any and all detainee activity is kept under constant
surveillance and security.

78

SOP at 2-4 (d) (2004).
SOP 2-4 (e) (2004).
80
SOP 2-4 (e) (2004).
81
SOP 2-4 (f) (2004).
82
SOP 2-4 (g) (2004).
83
SOP 2-4 (g) (2004).
84
SOP 19-1 (a) (2004).
85
SOP 11-1 (2004).
86
SOP 11-4 (2004).
87
SOP 11-4 (2004).
88
SOP 11-4 (2004).
79

15

___________________________________________
“There must be a continuous presence on the blocks by the
guards. At no time should the block not have a guard walking
89
up and down the block.”
- SOP 6-1(d) (2004)

___________________________________________

In addition to constantly walking the block, the SOPs also mandate headcounts to be
conducted at least every three hours to account for every detainee on the cell block.90 The guard
conducting the headcount must compare the Internment Serial Number (―ISN‖) number on the
ID bracelet with the ISN number on the Alpha roster, as well as the picture on the ID bracelet to
the detainee himself.91 Headcounts are to be done at the start of every shift, and the DOC calls
for an additional three randomly-timed headcounts throughout the remainder of the shift.92 ―The
most time between headcounts is three hours.‖93 A block guard must observe skin or movement
for every detainee on the block every ten minutes even during the overnight hours while
detainees sleep.94 The headcounts are entered into the DIMS, noting which guard conducted the
headcount and the results.95 ―Midnight shift will conduct [a] visual search of the cells and [the]
detainees every ten minutes by walking through the block.‖96 The midnight searches must also
be noted in the pass-on book and all unusual activity must be documented.97
Detainees are subject to intense intelligence-gathering operations.98 Not only are the
detainees routinely interrogated by Counterintelligence Agents but they are also constantly
watched by the guards themselves, who are then required to fill out various forms documenting
any suspicious activity or disturbances.99
3. Security Response Force
The Immediate Response Force (―IRF‖) is a five member team ―intended to be used
primarily as a forced cell extraction team, specializing in the extraction of a detainee who is
combative, resistive, or if the possibility of a weapon is in the cell at the time of the
extraction.‖100 The IRF team may also be called in during a self-harm incident.101 When the IRF
team is used, the SOPs require the SOG or PL to ensure that a video camera operator documents

89

SOP 6-1(d) (2004).
SOP 6-2 (2004).
91
SOP 6-2 (2004).
92
SOP 6-2 (f) (2004).
93
SOP 6-2 (f) (2004).
94
SOP 6-2 (g) (2004).
95
SJA at 22.
96
SOP 6-3 (2004).
97
SOP 6-3 (2004).
98
SOP 14-1–14-13 (2004).
99
SOP 14-13 (2004).
100
SOP 24-7 (2004).
101
SOP 24-7 (2004).
90

16

the entire incident.102 After the incident, the SOPs call for a Serious Incident Report to be
completed and submitted to the CJDOG, along with the video and copies of statements, all to be
kept as evidence.103
4. SOP Compliance Mandatory at All Times
The guards‘ knowledge and execution of the SOPs is central to the camp‘s security
mission.
Security is a series of checks and balances performed at various
levels both internal and external to the facility. It requires all
personnel to continually maintain an effective working knowledge
of rules, regulations, and special orders; maintain constant
vigilance throughout their daily duties; review/evaluate procedures
and initiate recommendations to proper authority for
improvements.104
The guards are required to maintain a ―[f]air, firm, and impartial enforcement of rules and
regulations‖ in order to facilitate control of the detainees.105 The guards are required to sign a
document stating that they are familiar with all the provisions of the SOPs.
The SOPs also state that ―[t]his policy is punitive in that a violation of any provision of
this policy may provide a basis for appropriate administrative or judicial/disciplinary action
under the Uniform Code of Military Justice (UCMJ), or appropriate military/civilian personnel
regulations, ejection from Camp Delta, and/or denial of entry.‖106 Therefore, should any portion
of the SOPs be violated, the perpetrator is subject to disciplinary action.

5. The Deaths
The three deaths are alleged to be coordinated suicides despite the intensive security and
protective measures of the Camp. The detainees were dead for ―at least‖ two hours before
discovery according to the government medical examiner.107 All detainees were reportedly alive
or accounted for at 22:00 on June 9, 2006, according to the NCIS Statement of Findings, and
found dead between 00:20 and 00:45.108 Assuming the victims were deceased for the minimum
amount of time possible according to the medical examiner, the detainees had 20 to 36 minutes
to simultaneously complete their suicides. None of the three detainees‘ cells was adjacent to any
other.

102

SOP 24-7 (2004).
SOP 24-9 (2004).
104
SOP 6-1 (c) (2004).
105
SOP 6-1 (a) (2004).
106
SOP 1-1 (d) (2004).
107
Autopsy Report for ISN 588 at 28; Autopsy Report for 693 at 19.
108
NCIS at 965; NCIS Statement at 1; Autopsy Report for ISN 093 at 1; Autopsy Report for 693 at 12; Autopsy
Report for 588 at 22.
103

17

A. What the Detainees had to do to Commit Suicide by Hanging
According to government investigations, the detainees had ―apparently taken their own
lives by hanging themselves with braided rope made from bed sheets and tee shirts.‖109 Each
detainee reportedly had a cloth mask around his face and cloth stuffed in his mouth and down his
throat, with his hands and feet bound together.110
Despite strict SOPs stating that detainees may only hang items to dry no higher than half
way up the cell walls, the guard statements allege that they were unable to see the detainees
hanging as sheets and blankets were arranged to obstruct their view.111 According to SOPs,
―[d]etainees may only hang wet clothing and linen items in cell windows so that they may dry.
Once dry, they must be removed.‖112
__________________________________________
“Blankets or sheets may be temporarily hung up, no higher
than half way up the cell walls, to provide privacy while using
the toilet. Once the detainee has completed using the toilet,
113
the blankets and sheets must be taken down.”
- SOP 6-21(d) (2004)

__________________________________________

Based on the government reports, each detainee individually must have performed a series
of ten tasks to create the opportunity to hang himself. Then, each detainee had to hang in his cell
long enough to die—all without a single guard noticing.
To successfully hang himself, each detainee had to (in no certain order):
1.
2.
3.
4.
5.
6.
7.

Tear, braid, and twist cloth into nooses114
Push his mattress up against the cell wall facing the tier115
Hang up sheets blocking the guards‘ view into his cells116
Create a mannequin of his body under sheets and/or blankets on his bunks117
Tie his feet together118
Tie his hands together 119
Stuff cloth in his mouth and down his throat120

109

NCIS Statement at 1.
NCIS at 938, 950, 966, 975.
111
SOP 6-21(d) (2004). NCIS at 950, 975, 1039, 990, 966.
112
SOP 6-21 (d) (2004).
113
SOP 6-21 (d) (2004).
114
NCIS at 958, 966, 1024, 1031, 1039; CITF at 34, 41, 44, 47. Blankets and sheets are comfort items. It is unclear
why two of the detainees (693 and 588) would have these comfort items for good behavior after they just were taken
off force feeding procedures for refusing to eat. (NCIS at 1062).
115
NCIS at 950, 958; CITF at 37.
116
NCIS at 946, 949, 958, 965; CITF at 31, 34, 37, 44, 45, 47. SOP 6-21 (d) (2004).
117
NCIS at 1062.
118
NCIS at 950.
119
NCIS at 950, 958, 975, 1091, 1094; CITF at 34, 44, 45.
110

18

8. Wrap his face and head in cloth to make a mask121
9. Hang a noose from the top of the cell wall122
10. Step up onto the ledge of the sink and step off the edge123
The government describes this as the manner in which the detainees disguised their cells and
successfully hanged themselves without guards detecting an incident of self-harm.

B. Description of the Corpses
The guards who reported discovering the detainees‘ bodies after midnight reported that
they were found hanging in their cells with their feet dangling just off the ground.124 The hands
and feet of each detainee was bound, a mask covered each detainee‘s face, and rags were lodged
in each of their mouths and down their throats.125 Guards and medical personnel similarly
described each of the bodies as having the following conditions:









Rigor mortis126
Cool or cold to the touch127
Blue feet and extremities128
Stiff129
Jaw clenched130
Not breathing131
Abrasion around the neck132
Fixed or dilated pupils133

Upon arrival at the clinic, the automated external defibrillator (AED) did not detect a
shockable rhythm.134 The medical personnel tried to pry the detainees‘ jaws open to remove the
120

NCIS at 938, 950, 959, 966, 975, 1073, 1079, 1091, 1093, 1097; CITF at 32, 49, 50. The investigative reports and
the autopsies provided no explanation for why the three detainees each had cloths in their mouths and deep in their
throats.
121
NCIS at 946, 950, 966, 975; CITF at 32, 34, 37, 41.
122
NCIS at 975; CITF at 32, 34, 37, 45. See 2004 SOP at 6.9 (Hanging anything from the ceiling is in violation of
the SOPs.)
123
NCIS at 1004 (noting that ―ISN-693 was suspended approximately six (6) inches from the deck. No part of his
body was in contact with the deck‖; NCIS at 1031 (―I saw the detainee‘s feet off the ground approximately one and
a half inchers with no shoes on‖); NCIS at 950 (―The detainee was suspended above the floor on the side of the
cell…‖); NCIS at 975 (―…I saw the detainee hanging fully suspended off the floor of his cell‖). See also CITF at 45
(in which one guard stated that he ―saw ISN 093 hanging from the ceiling‖).
124
NCIS at 950, 991, 1004.
125
NCIS at 950, 975, 938, 966, 1073-74, 1025, 958, 1024, 1079, 1091.
126
NCIS at 1071, 1078-9.
127
NCIS at 1071, 984, 943, 1019.
128
NCIS at 950, 974, 984, 943, 1019, 1073, 1024.
129
NCIS at 1070, 1073, 1024.
130
NCIS at 1071, 1085, 1079, 1073.
131
NCIS at 1078, 1068, 1092.
158
NCIS at 1071, 1085, 1004.
133
NCIS at 1070, 1108, 1003, 1024.
134
NCIS at 1070, 1078, 1097, 1080, 1091.

19

cloth.135 In one instance, the medics broke at least one of the detainee‘s teeth during the
attempt.136 The medical personnel performed CPR on each of the three detainees for as long as
30 minutes.137 Both Al Tabi and Ahmed were declared dead at 01:15 according to the guard
statements.138
According to the accounts reported in the NCIS and CITF investigations, not one of the
three detainees exhibited any sign of life from the moment they were discovered, throughout the
medical response, until they were declared dead at the clinic or the hospital.139 Each detainee is
described as having an airway obstructed by a piece of cloth and bound hands, feet, and neck.
These facts are not explained by the investigations.
Because no doctor was on staff at the time of his arrival, Al Zahrani was transported to
the Naval Hospital.140 During the ride, the medics finally removed the cloth wrapped around the
detainee‘s neck, which caused the detainee to ―expel[] blood from his nose and mouth.‖141 At the
hospital, the medics continued attempts to revive Al Zahrani for approximately one hour, after
which he was declared dead at 01:50.142

C. Autopsies
The Armed Forces Institute of Pathology conducted autopsies on each detainee on June
10, 2006, the day of their reported deaths. The autopsies report that each detainee was discovered
at approximately 00:20.143 The detainees‘ bodies began arriving at the clinic 28 minutes after
discovery.144 All three had arrived by 00:58.145 The autopsy report for each detainee lists the
manner of death as suicide by hanging.146 The evidence of hanging is based upon the ligature
that was found wrapped around each detainee‘s neck and the circumferential dried abrasion
furrow around the neck.147 The furrow is described as being imprinted with the very fine weave
pattern of the ligature, creating an inverted ―V‖ on the back of the head consistent with a hanging
victim.148
The autopsy report describes the detainees‘ condition at the time of discovery as ―in rigor
mortis.‖149 Rigor mortis is considered to be an indication of death and no amount of resuscitation

135

NCIS at 1071, 1085.
NCIS at 1091.
137
NCIS at 1070, 1078, 1097, 1094, 1091.
138
NCIS at 1069, 1079.
139
NCIS at 1068. One medic described ISN 588 as having a faint pulse, but no other medic confirmed this.
140
NCIS at 1071.
141
NCIS at 1103.
142
NCIS at 1016-17, 1113.
143
Autopsy Report for ISN 093 at 1; Autopsy Report for ISN 588 at 22; Autopsy Report for ISN 693 at 12.
144
Autopsy Report for ISN 093 at 1.
145
Autopsy Report for ISN 693 at 12; Autopsy Report for ISN 588 at 22.
146
Autopsy Report for ISN 093 at 1; Autopsy Report for ISN 588 at 22; Autopsy Report for ISN 693 at 12.
147
Autopsy Report for ISN 093 at 4; Autopsy Report for ISN 588 at 25; Autopsy Report for ISN 693 at 15.
148
Oxford American Dictionary, Herald Colleges Edition, 1980 (―A long cut in the ground made by a plow or other
implement. 2. A groove resembling this, a deep wrinkle in the skin.‖).
149
Autopsy Report for ISN 093 at 4; Autopsy Report for ISN 588 at 22; Autopsy Report for ISN 693 at 12.
136

20

offered after it sets in will be effective.150 Both autopsy reports for Al Tabi and Ahmed state that
the detainees were dead at least two hours prior to discovery.151 The autopsy of Ahmed also
revealed a broken hyoid bone.152 The hyoid is located within the neck and is a distinct sign of
manual strangulation when broken.153
Lifesaving attempts used on the detainees included a nasal airway, an oral-gastric tube,
an orally-placed endotracheal tube, an intravenous catheter, a urinary bladder catheter, and
multiple electrocardiogram pads on their chests.154

D. Estimated Time of Death
By the accounts of the medical examiner, all three detainees were dead and hanging in
their cells for an extended period of time without being noticed. The medical examiner from the
Armed Forces Institute of Pathology concludes that detainees Al Tabi and Ahmed were deceased
for ―at least a couple hours prior to the discovery.‖155 The medical examiner did not include a
similar time frame for Al Zahrani, although the condition of his body was similar to that of the
other two deceased detainees. Descriptions of the condition of the bodies upon discovery indicate
that they were deceased for more than two hours.
1. Dried Abrasion Furrow
The government‘s SJA Report contains an essay written by Dr. Dean Hawley, a Professor
of Pathology at Indiana University and an expert in the field of strangulation and asphyxiation
deaths.156 The essay describes the creation of ligature abrasions on a hanging victim:
External injury including the dramatic ―rope burns‖ or ligature abrasions only
occur after the body has been suspended for several hours after death. If the
ligature is released at the moment of death, there will be no mark in the skin.
Leave the body hang[ing] suspended by the ligature for a few hours, and a very
dramatic furrow and ligature abrasion will develop post-mortem.157
According to Dr. Hawley‘s explanation, the presence of dried abrasion furrows on each of the
detainees‘ necks indicates that they were hanging post-mortem for several hours.

150

Richard W. O. Beebe & Deborah L. Fink, Fundamentals of Emergency Care 37 (Delmar 10th ed. 2001).
[Hereinafter Fink]
151
Autopsy Report for ISN 588 at 28; Autopsy Report for ISN 693 at 19.
152
Autopsy Report for ISN 693 at 13.
153
Clinically Oriented Anatomy, 6th Ed. by Keith L. Moore, Arthur F. Dalley II, Anne M. R. Agur.
154
Autopsy Report for ISN 093 at 3; Autopsy Report for ISN 588 at 24; Autopsy Report for ISN 693 at 14-15.
155
Autopsy Report for ISN 693 at 19; Autopsy report for 588 at 28.
156
SJA at 223.
157
SJA at 226.

21

2. Rigor Mortis
Rigor mortis is the stiffening of the body after death.158 Rigor mortis normally presents
itself between two and four hours after death and fully develops after more than six and up to
twelve hours.159 It first manifests itself in the small muscles, such as the eyelids and jaw, and
then gradually it spreads to larger muscle groups.160
The guards and medics describe all three detainees as stiff with rigor.161 Not only had
rigor mortis set in the detainees‘ small facial muscles, but their limbs were also described as
being stiff.162 Such an advanced level of rigor mortis indicates that the detainees were dead for
significantly longer than two hours, all the while under continuous guard presence.163
3. Body Temperature
The post-mortem body cools at an average rate of 1.5 degrees per hour during normal air
temperatures of 70 to 75 degrees Fahrenheit.164 The rate of cooling can be affected by air
temperature. The closer one‘s body temperature is to the air temperature surrounding the body,
the slower the rate of change in body temperature.165
Each of the detainees was described as ―cold to the touch‖ by no fewer than four camp
personnel.166 The warm climate of Guantánamo would have slowed the body‘s rate of cooling.
The coldness of the bodies indicates that the bodies were hanging for a long period of time.
4. Hang Time
As described in the preceding paragraphs, there is medical evidence the detainees were
hanging in their cells for a significant period of time. It is unclear how the detainees had been
hanging for such a period of time when the camp‘s security is predicated on procedures that the
guards must follow while monitoring the detainees. ―Custody and control measures maintain
good order and discipline and protect the welfare of all personnel and detainees alike.‖167

158

Forensic Pathology at 27.
Forensic Pathology at 26.
160
Forensic Pathology at 26.
161
NCIS at 1070, 1071, 1078-9.
162
NCIS at 1070, 1073, 1024.
163
SOP 6-2 (f) (2004). (―A headcount will be conducted at the start of each guard shift. The DOC will then call for
an additional three randomly timed headcounts throughout the guard shift. The most time between headcounts is
three hours.‖)
164
Forensic Pathology at 26.
165
Forensic Pathology at 27.
166
NCIS at 950, 1073, 1024.
167
SOP 6-1 (a) (2004).
159

22

__________________________________________
“There must be a continuous presence on the blocks by the
guards. At no time should the block not have a guard walking
168
up and down the block.”
- SOP 6-1(d) (2004)

__________________________________________

The SOPs demand that the guards maintain a heightened level of vigilance and alertness
while watching the detainees. ―Supervision of detainees consists of much more than observing
detainee conduct and activity. Supervision includes searching the detainee‘s person, his billeting
areas, conducting counts, conducting night inspections of billeting areas, and maintaining a high
level of alertness to prevent escapes, violence, sexual incidents, or other disturbances.‖169 To
effectively supervise the detainees, the guards must maintain a ―continuous presence‖ on the
blocks.170
5. Summary
The government medical examiners concluded that two of the three victims, Al Tabi and
Ahmed, were deceased for at least two hours.171 The government‘s experts, its research of the
science of pathology, and its physical descriptions of the bodies, each indicate that all three
victims were dead for several hours or more upon discovery. Accepting the minimum time that
the government‘s examiner believes the detainees were dead, the three men hung in their cells,
while under continuous surveillance, for two hours.

6. June 9 and 10, 2006
The NCIS, CITF, and SJA investigations concluded that three detainees died in their cells
on Alpha Block. The interviews from the investigations recount a series of events that occurred
after the guards came on duty the night of June 9, including what the guards were doing before
discovering the bodies, how they discovered the bodies, and the events that occurred after the
detainees were found and pronounced dead.172
The investigations focused on Alpha guards, including their officers, and medical
personnel. In addition, the investigations included interviews of detainees, Escort Control, other
officers, and six other guards not assigned to Alpha Block. Although there are hundreds of pages
of interviews and information, it is impossible to discern who was responsible for walking the
block when the detainees died or for failing to notice the detainees hanging for two hours. The
investigation did not examine the duty roster for the night.173

168

SOP 6-1(d) (2004).
SOP 6-1 (b) (2004). Billeting is military parlance for the lodging area assigned to each detainee.
170
SOP 6-1 (d) (2004).
171
Autopsy Report for 693 at 18; Autopsy Report for 588 at 28.
172
See Appendix D and E.
173
The duty roster is formally called ―Guard Shift Manning Roster.‖ SOP 5-3(f) (2004).
169

23

Because the personnel are unnamed in the investigations, each person is labeled for
reference purposes according to his or her position and given a number. For example, Alpha
guards are referred to as AG1, AG2, AG3, and AG4.174 The following timeline of events was
created from all interviews provided in the NCIS and CITF investigations. NCIS and CITF
interviewed several other guards not on duty on Alpha block that night but who witnessed some
of the events that occurred. 175 Some parts of the statements by personnel not assigned to Alpha
corroborate some aspects of the Alpha guards‘ statements. Due to their importance—and the
amount of detail they contain—the Alpha Guard statements are cited more than others.

A. Climate of the Camp
__________________________________________
“....[O]n the night in question, another detainee (who did
not later commit suicide) had walked through the cell block
telling people „tonight‟s the night.‟”176
- NCIS Statement of Findings

__________________________________________

In the weeks leading up to the three deaths, the guards and officers were on high alert.
According to NCIS, there had been 44 reported suicide attempts prior to June 9, 2006, and more
recent events including a detainee riot on May 18, 2006, increased the need for special
vigilance.177
Higher authorities sent out messages to guards on May 28 and May 30, 2006, to warn that
a violent act might take place in the future and held trainings in order to teach appropriate
procedures and ―to reiterate the seriousness of the threat[s].‖178 In an interview with Fox News
commentator Bill O‘Reilly just a day before the deaths, the Commander stated that ―the
detainees were planning something more violent.‖179

174

See Appendix A.
See Appendices E, F, and G for more information regarding the contents of the interviews.
176
NCIS Statement at 2.
177
NCIS at 462. See William Branigin, Six Gitmo Inmates Hurt in Fight With Guards, THE WASHINGTON POST,
May 19, 2006, available at http://www.washingtonpost.com/wpdyn/content/article/2006/05/19/AR2006051900605.html (On May 18, 2006, the some detainees rioted against the
guards by feigning suicide to lure guards into their cells and then attack them with make-shift weapons. Two days
before the incident, two detainees attempted to commit suicide by taking large quantities of medication they
hoarded.). See, e.g., SJA at 135 (noting that ―[t]here was always a general level of threat of suicide in the camp
however, the weeks before the Alpha Block incident the threat level was HIGH. This was due to intelligence leading
the command to believe an incident of a mass self harm was eminent [sic]‖); See also NCIS at 1063.
178
NCIS at 1063; SJA at 135.
179
NCIS at 1063.
175

24

B. Emergency Procedures
Camp Delta has a series of procedural codes for dealing with medical emergencies such
as attempted suicide or self-harm.180 First, the guard must call a ―Code Blue,‖ meaning the
detainee has no heartbeat and/or respiration and requires immediate medical care, triggering a
response from a variety of personnel.181 Guard responsibilities in the event of a Code Blue
include:




Radio the location of the incident and identify it as a ―Code Blue,‖182
Request medical assistance at the location of the incident directly from the medical
personnel,183
Render medical care in accordance with their level of training until medical personnel
arrive.184

The DOC will dispatch administrative personnel with video cameras and Escort Control
guards to assist with the transport to the clinic.185
The block NCO then ensures that at least one person continues to walk the tier, observes
the other detainees, and secures the cell after the detainee is removed to prevent tampering with
potential evidence.186 Then, the NCO must fill out a DA Form 2823 regarding the incident and
ensure that all other guards complete a form. 187 The Commander must also fill out a similar
report following the incident.188

C. Actions of the Guards, Medics, and Detainees Prior to Discovery
of the Bodies
___________________________________________
“There must be a continuous presence on the blocks by the
guards. At no time should the block not have a guard walking
189
up and down the block.”
- SOP 6-1(d) (2004)

__________________________________________

In Alpha Block, cells A-8, A-12, and A-5 are located on the left side of the tier; on the
night in question, cell A-5 was separated from cell A-8 by two empty cells, and cell A-8 was
180

SOP 19-6 (a) (2004).
SOP 19-6 (c) (2004).
182
SOP 19-6 (c) (1) (a) (2004).
183
SOP 19-6 (c) (1) (a) - (b) (2004).
184
SOP 19-6 (c) (1) (c) (2004).
185
SOP 32-1 (e) (4) - (5) (2004).
186
SOP 32-1 (e) (4);(8) (2004).
187
SOP 32-1 (e) (10) (2004).; see also SOP 6-15 (d)(2)(2004). (DA Form 2823 is a sworn statement in which the
person completing it recounts exactly what occurred during the reported incident.)
188
SOP 32-1 (g) (2004).
189
SOP 6-1(d) (2004).
181

25

separated from cell A-12 by one empty cell and two occupied cells.190 At 22:00, the lights were
shut off on the side of the block where all three cells were located, so that it would be darker
while the detainees slept.191 At this time the guards were to walk the block in half hour
intervals.192
Those in charge that night included the Commander, Camp 1 PL, and the SOG.193 Escort
Control guards were also on duty.194 Alpha Block staffed five guards, including the NCO or
block leader. 195 Colonel Bumgarner served as the warden of Guantánamo Bay and was the
Commander of the Joint Detention Group at Camp Delta from April 2005 to June 2006.196 He
was ―responsible for a guard force ofmore than1000 individuals whose mission is to provide safe
care and custody to all detainees.‖197 He also oversaw the implementation and development of
the SOPs.198
Admiral Harris commanded the Joint Task Force Guantánamo (JTF GITMO) from
March 2006 to May 2007.199 He previously served as the Director of the Information, Plans, and
Security Division for the staff of the Chief of Naval Operations where he was responsible for
Navy operations and anti-terrorism/force protection policy.200
The June 9, 2006 day shift proceeded normally on Alpha Block.201 The night shift
reported for their assignments at approximately 17:15.202 Like other nights, the guards performed
a headcount of the detainees at the start of the shift at 18:00.203 The guards then served dinner to
the detainees.204 Afterwards, the detainees had a call to prayer and sang until around 21:30.205
During this time, the DOC sent a headcount request to be entered into the DIMS system.206 The
headcount reported that 28 detainees were ―present‖ and/or ―accounted for‖ and that five guards
were present on Alpha Block.207

190

SJA at 11.
SJA at 14; NCIS at 1056.
192
SJA at 14.
193
SJA at 19–20.
194
SJA at 20.
195
NCIS at 1061; CITF at 35.
196
Tim Golden, The Battle for Guantánamo, THE NEW YORK TIMES MAGAZINE, Sept. 17, 2006, available at
http://www.nytimes.com/2006/09/17/magazine/17guantanamo.html?pagewanted=all. At the time of the suicides,
Colonel Bumgarner had more than 24 years of experience as a military police officer. Id.
197
NCIS at 1054.
198
NCIS at 1054, 1056.
199
United States Navy Biography: Admiral Harris, http://www.navy.mil/navydata/bios/bio.asp?bioID=136.
Following his tenure at JTF GITMO, Admiral Harris served as the Director of Operations for SOUTHCOM. Id.
200
Id.
201
NCIS at 993.
202
NCIS at 964.
203
NCIS at 957; See NCIS at 982 (states headcount was requested at 17:35).
204
NCIS at 973, 948, 982; CITF at 36.
205
NCIS at 949, 965; CITF at 36.
206
The guard interviews note the headcount request occurred at 20:17. NCIS at 974, 949. However, the SJA report
states that the headcount was ordered at 2004. SJA at 12.
207
SJA at 12; CITF at 36.
191

26

All the detainees were last seen alive around 21:30 that night, according to the Alpha
guard interviews. 208 At that time, an Alpha guard was specifically assigned to walk the block.209
That person was not identified.
___________________________________________
[Redacted] stated he walked the block between 2330 and 2400
or 0000 to 0030…”210
- Name redacted

__________________________________________

At 23:00, AG2 walked the block with the PL.211 At this time other guards did a walkthrough of the block, as well.212 The DOC ordered a DIMS headcount at 23:35, which recorded
that at 23:50, 28 detainees were ―present‖ and ―accounted for‖ and five guards were present on
Alpha Block. 213
__________________________________________
“At 2350…a headcount was conducted…” 214
- Name redacted

__________________________________________

No guard noted anything suspicious while on duty at that time. Medical personnel also
walked the block between 21:37 and 21:49 handing out medication to the detainees and reported
nothing unusual.215
On June 10, 2006, AG1 reported beginning his shift to walk the block at 00:00.216 Shortly
thereafter, AG3 traded shifts with AG1, and AG1 returned to the guard shack while AG3 took
over the duty of walking the block.217 AG3 reported entering Alpha Block around 00:36 to take
over that half-hour shift.218 Shortly thereafter, he discovered Al Zahrani.219

208

NCIS at 965 (Alpha Guard 2 was ―positive that all three detainees were alive when [she] completed sweeping‖).
Although the NCIS Statement of Findings states that all detainees were alive at 22:00, the interviews only confirm
that the latest the detainees were seen alive is 21:30.
209
NCIS at 958.
210
NCIS at 921.
211
SJA at 33; NCIS at 965; CITF at 35.
212
NCIS at 965.
213
SJA at 14-15; see also NCIS at 950 (No guard reports knowing who conducted the headcount at this time.).
214
NCIS at 921.
215
NCIS at 1084; see also NCIS at 1093, 1088.
216
NCIS at 958; CITF at 31.
217
NCIS at 958; CITF at 31.
218
NCIS at 974; CITF at 36.
219
NCIS at 974; CITF at 36.

27

__________________________________________
“[O]ther detainees make it urgently and loudly known that a
220
detainee was carrying out some type of self-harm.”
- Name redacted

__________________________________________

Prior to that time, there is no indication that either the guards or the other detainees
observed anything unusual. In past detainee self-harm attempts, ―other detainees make it urgently
and loudly known that a detainee was carrying out some type of self-harm.‖221 Despite their
ability to see into other cells, no detainee alerted the guards to any acts of self-harm that night,
nor did the guards, who were on high alert, notice anything unusual that night.

D. Discovery of the Bodies According Guard Statements
According to guard interviews obtained by the investigation, at 00:00, AG1 walked the
cell block and reportedly continued without noticing any suspicious activity. 222
AG3 came on the block at 00:36-00:37, asked to trade half-hour shifts with AG1, and
took over the guard duty on the block.223 AG3 began walking down one side of the tier, checking
cells.224 When AG3 arrived at cell A-8, at approximately 00:40-00:45, he tried to locate Al
Zahrani but was unable to do so.225 AG3 went to the guard shack for assistance, where AG1,
AG2 and the Block NCO were present.226 AG3 entered the guard shack and asked AG1 to come
look at a cell; AG1 followed him to cell A-8.227 Upon calling his name, the detainee did not
respond.228 At this point, AG1 went to the guard shack to get someone whose name is redacted
from the file.229
According to AG2‘s report, she returned to the guard shack around 23:40 (according to
NCIS) or 00:40 (according to CITF).230 Two minutes later AG1 ran in shouting that he thought
Al Zahrani was attempting self-harm.231 The NCO tapped on the bean hole to get Al Zahrani‘s
attention.232 When he could not obtain a response from him, the NCO opened the bean hole and
tugged on the detainee‘s blanket until it came off the bunk, revealing a comfort items arranged to
look like a body.233 AG2 unlocked a neighboring cell, A-7, and jumped on the bed to get a visual

220

NCIS at 1063.
NCIS at 1063.
222
NCIS at 958.
223
CITF at 36.
224
NCIS at 974; CITF at 37.
225
NCIS at 975; CITF at 37.
226
NCIS at 965; see also CITF at 34; NCIS at 950.
227
NCIS at 958.
228
NCIS at 958.
229
NCIS at 958.
230
NCIS at 965. CITF at 34.
231
NCIS at 958, 965.
232
NCIS at 950.
233
NCIS at 950.
221

28

of Al Zahrani.234 From A-7 another guard was able to push the sheet aside to see Al Zahrani
hanging.235
__________________________________________
“There were white sheets crammed in his mouth and he
236
appeared blue and lifeless.”
- Name redacted

__________________________________________

Someone (name redacted) went outside Alpha Block to peer into cell A-8 from the
outside rear window and started yelling, ―[H]e‘s hanging, he‘s hanging.‖237 AG2 unlocked A-8
and entered the cell along with AG1, AG3, and the NCO.238 Al Zahrani was hanging behind
blankets with a sheet wrapped around his neck and his hands were bound together.239
Someone shackled his arms, and AG1 and AG2 both reported shackling his legs.240 AG3
recalls that zip ties were used on Al Zahrani‘s wrists and ankles instead of shackles.241
The NCO tried to pull the cloth lodged in the detainee‘s mouth and throat.242 AG1 and
the NCO both tried to obtain a pulse, but there was none.243 The detainee looked dead, and it
appeared as if rigor mortis had set in.244 The guards placed Al Zahrani on a backboard and
transported him to the medical clinic.245
The SOG and PL arrived on Alpha Block as military personnel were bringing Al Zahrani
out of cell A-8.246 The PL went to the guard shack and called the DOC requesting a medical
response; no medical response ever occurred. 247
As noted above, the proper SOP required the guards to call a ―Code Blue‖ which refers to
a critical life-threatening medical condition, such as where the detainee is not breathing or has no
heartbeat.248 The steps for a ―Code Blue‖ call were not taken on June 9-10, according to
government documents.

234

NCIS at 966.
NCIS at 966.
236
NCIS at 950, 959, 975.
237
NCIS at 975, 950; see also CITF at 37; CITF at 969 (―At this time, some of the detainees had awoke from the
noise and were saying, ‗Shhh! Quiet!‘‖)
238
NCIS at 966, 950, 975, 958.
239
NCIS at 950, 958.
240
NCIS at 966.
241
NCIS at 975.
242
NCIS at 950, 966.
243
NCIS at 966.
244
NCIS at 959, 966.
245
NCIS at 950, 959, 975, 983.
246
NCIS at 941, 943, 938.
247
NCIS at 938. NCIS at 943.
248
SOP 32-1(a) (2004).
235

29

That night, however, the four block guards, the NCO, and the Platoon leader all
transported Al Zahrani to the medical clinic.249 There are no reports of any guards left on the tier
at that time. Instead of checking cells, the SOG went back to the NCO shack.250 The IRF Guard,
who went to Alpha Block on his NCO‘s orders as the Alpha guards carried Al Zahrani to the
clinic, described that for that moment ―the block was empty of guards because they were all
attending to ISN 93.‖251 According to the government investigation, no one noticed that there
were any other detainees hanging dead in their cells.
Shortly after hearing of the first incident with Al Zahrani, the primary IRF guard waited
for the call for the IRF team to respond; no such call came, nor did any other IRF guards run to
get their gear from the station.252
Subsequently, other guards discovered Al Tabi hanging in his cell. A few minutes later
Ahmed was found in similar state. The Alpha guards arrived back on the block at this time.253
AG2 unlocked the door to A-12 and found Al Tabi‘s body hidden behind a sheet.254 The other
detainees on the block ―were awake and verbally communicating‖ at this time.255
Al Tabi‘s condition, as described by the guards, included signs of rigor mortis, blue feet,
and cold extremities.256 A makeshift rope was tied around his neck, and ―what looked like a tshirt…cut up to make sort of a mask‖ was wrapped around his face.257 Escort Control 2 checked
Al Tabi‘s pulse, but ―detected no signs of life.‖258 Guard 3, Guard 1, and Escort Control 4 all
arrived to assist the IRF guard and AG4 to take him off of the tier and to the clinic.259
Observing the commotion from the tier, the SOG called the tower to have the sally gate
opened.260 After returning from the clinic, AG1 inspected the block but was not immediately able
to locate Ahmed in cell A-5.261 When found, Ahmed had material around ―at least one wrist‖
and ―cloth material around his neck.‖262 Escort Control 5 was ―immediately struck with how
deep the indentation [from the rope around his neck] was.‖263 His body was ―blue‖ and ―stiff‖

249

NCIS at 938, 959, 966, 975, 984, 1032.
NCIS at 943.
251
NCIS at 1038-1039.
252
NCIS at 1038. The SOPs state that IRF teams are generally supposed to be used in these situations although it is
not always required. ―If the detainee's condition is or becoming life threatening, and only two to three block guards
are available, they [can] form an entry team and enter the cell to secure and attend to the detainee. The guards do not
have to wait for the IRF team, they can take immediate action if the block NCO, according to his/her best judgment,
deems he/she can control the situation to secure and safeguard the detainee.‖ SOP 32-1 (d) (2004).
253
NCIS at 966, 975, 959, 950.
254
NCIS at 966.
255
CITF at 1044.
256
NCIS at 942, 984.
257
NCIS at 991; see NCIS at 1039.
258
NCIS at 1003.
259
NCIS at 1042, 1032, 1019, 984, 1039.
260
NCIS at 944.
261
NCIS at 959.
262
NCIS at 1024.
263
NCIS at 1024.
250

30

yet still ―pliable.‖264 Once strapped to a backboard, Escort Control 5, Escort Control 6, and
Escort Control 2 took Ahmed to the clinic.265
Before being transported to the DET clinic, each of the detainees‘ bodies was shackled as
per the SOPs and put on a backboard. All four Alpha guards and the Alpha Block NCO left their
post unattended to transport Al Zahrani to the medical clinic.266
1. Medical Response for Al Zahrani
Around 00:40, a nurse at the DET Clinic received a call that a detainee with no pulse was
being brought to the clinic.267 ―Normal operating procedures state that [medical personnel]
respond to the cell for medical care.‖268 Non-medical personnel delivered the detainee to the
clinic.269 According to statements the guards made that night, the medics did not know that the
bodies were coming, the condition of the bodies, or the cause of death.
The guards described the medics as completely unprepared for and unaware of the
emergency situation.270 The guards had to knock on the doors to get into the DET Clinic, and
once inside, the ―medical personnel were just standing around at first,‖ unsure of how to
proceed.271 Personnel walked around casually and slowly putting on their blouses.272 The doctors
were coming out of different rooms and ―did not administer care to [Al Zahrani] for
approximately two to three minutes.‖273
__________________________________________
“The corpsman trying to call the doctor on call could not find
the number, so I stepped away from the detainee to call
911…” 274
- Name redacted

__________________________________________

264

NCIS at 1024, 1044.
NCIS at 1044, 1024, 1004.
266
NCIS at 959, 966, 975, 984.
267
NCIS at 1068; see NCIS at 1073 (00:30-00:35); NCIS at 1070 (00:43).
268
NCIS at 1068.
269
NCIS at 1068. This assessment conflicts with the autopsy report which states that it took the guards 28 minutes to
remove 093 from his cell and transport him to the clinic. Autopsy Report for ISN 093 at 1.
342
NCIS at 959 (―Once we arrived at the medical unit, it appeared as if the medical personnel were not
prepared. Some of them had their blouse tops off and they scrambled out of different rooms. We placed him on
a bed while a female Captain put her blouse on. REDACTED stayed at the medical unit and we all went back to
the block.‖); NCIS at 966 (―We transported 93 to medical and when we got there we pounded on the door. I
opened the door and screamed ‗we got something serious‘. People were casually walking out of random rooms
and slowly putting on their stab vests and blouses. They didn‘t even know what room to put him in. They
appeared to be more interested in just looking at him than trying to help. I told them they needed to remove the
rag from his mouth and that we had already tried. REDACTED told us to get back to Alpha Block.‖).
271
NCIS at 950, 975.
272
NCIS at 966, 984.
273
NCIS at 984.
274
NCIS at 1070.
265

31

The medics‘ descriptions confirmed the guards‘ reports that the detainees were
unresponsive, cold, and stiff, with fixed dilated pupils and a locked jaw.275 Statements from
medical personnel reported that the medics responded promptly by administering CPR, hooking
up an IV, and getting the AED set up, in accordance with the SOPs. Further, the medics had to
pry the detainees‘ mouths open in order to insert tubes.276
During this time no doctor was present at the scene.277 The medics had to call 911 to get a
doctor because the corpsman could not find his number at the clinic.278
__________________________________________
“There was material jammed into his mouth.” 279
- Name redacted
“I told them they needed to remove the rag from his mouth
and that we had already tried.” 280
- Name redacted

__________________________________________

An ambulance arrived to take Al Zahrani to the Naval Hospital located on the edge of
Camp Delta.281 While en route, the EMTs discovered that cloth was lodged in Al Zahrani‘s
mouth and throat, blocking his airway.282 One medic reported that his heart was beating during
the ambulance ride;283 however, no other interview confirms that his heart was beating at any
time. About halfway through the ride, the detainee began expelling ―thick and orange‖ blood
from his mouth.284 The medics then noticed a piece of material wrapped several times around his
neck, though they were never able to cut all the way through it.285 The commanding officer of
the hospital pronounced Al Zahrani dead at 01:50.286

275

CITF at 1049.
NCIS at 1070, 1073. Medical SOP 68: Emergency Medical Treatment SOP at 15-17.
277
NCIS at 1070.
278
NCIS at 1070-1071. See also NCIS at 920 (NCIS investigators were not able to retrieve the logs for the JTFGTMO medical emergency call on June 10, 2006. ―[REDACTED] determined the recording system had
experienced a power failure and had not be reactivated properly.‖).
279
NCIS at 975.
280
NCIS at 966.
281
NCIS at 1071; Contra CITF at 49, 50 (stating Al Zahrani was pronounced dead at 01:05 prior to his transport to
the Naval Hospital.). Upon arrival, the two EMTs went into the clinic to get detainee 093. The nurse interviewed on
page 1081 was asked to drive the ambulance to the clinic while the EMTs worked on the detainee. No explanation
was provided as to why the nurse drove the ambulance to the clinic or whether the nurse was qualified to drive the
ambulance.
282
NCIS at 1103. The detainee also ―began expelling blood from his nose and mouth‖ when the material was
cut away from his neck.
283
SJA at 118–19 ("When the corpsman checked the first set of vitals in the ambulance, he said the detainee's heart
was beating, and I observed this on the monitor. But I am not sure if his heart was beating on its own or if we were
doing it. The heart beat was up and down the whole way to the hospital").
284
SJA at 119; see also NCIS at 998.
285
SJA at 119
286
NCIS at 1113.
276

32

2. Medical Response for Al Tabi and Ahmed
Guards and Escort Control arrived at the DET Clinic with Al Tabi when personnel began
taking Al Zahrani to the ambulance just before 01:00.287 Ahmed arrived shortly thereafter.288 No
guards told the medics how the detainees were found.289
__________________________________________
“The[n] he tried to tube him but we could not get his jaw
open. REDACTED used a lyroscope…blade, which is made of
metal, to pry the detainee‟s mouth open and in doing so broke
some of the detainee‟s teeth. Once the mouth was open we saw
that there was a big piece of cloth lodged in the back of the
detainee‟s mouth. REDACTED extracted it with the forceps
and it appeared to take a good amount of force to get it out.
Once it was out I saw that it was folded repeatedly on itself
and nearly as big as a wash cloth that was folded once in
half.”290
- Night Shift Team Leader at the DET clinic

___________________________________________

The detainees‘ mouths were shut so tightly that medics were unable to pry them open to
clear the airway.291 The doctor had to use a special instrument to open each detainee‘s mouth.292
Two combat camera personnel filmed two detainees with digital camcorders but ―Colonel B told
them to stop fairly quickly.‖293
After a half hour of administering CPR, the Senior Medical Officer (SMO) pronounced
Al Tabi dead at 01:15.294 Ahmed received CPR for about forty-five minutes, after which a doctor
arrived and tried to intubate him.295 Ahmed was also pronounced dead at 01:15.296
3. Aftermath
Admiral Harris arrived at around 01:00 and called the medics into a meeting to give them
a ―pep talk‖ and praise their efforts, stating the detainees were most likely dead on arrival. 297

287

NCIS at 1070–71, 1073.
NCIS at 1069.
289
NCIS at 1079 (―I never heard anyone describe how the detainees were found.‖).
290
NCIS at 1079.
291
NCIS at 1025, 1020.
292
NCIS at 1044.
293
SJA at 118; NCIS at 998; See NCIS at 1004 (―Someone called for a combat camera. I am combat camera
qualified so I volunteered to videotape the event. I ran the video camera for approximately two (2) minutes until I
was instructed by [REDACTED] to halt taping‖). The SOPs also require that the DOC ―dispatch the admin [sic]
personnel with the camera, extra disks and extra battery to the incident site‖ in the event of an attempted self-harm.
SOP 32-1 (e)(4) (2004).
294
NCIS at 1069; CITF at 49.
295
NCIS at 1044.
296
NCIS at 1079; CITF at 49.
288

33

This meeting occurred before the Al Tabi and Ahmed were declared dead at 01:15.298 At that
time two Escort Control guards were assigned to monitor their bodies.299 Between 02:00 and
03:00, both a chaplain and a cultural advisor came to and then left the clinic.300 Local NCIS and
CITF agents arrived shortly thereafter.301 Sometime before 06:00, the bodies were transported to
the morgue.302 The medical staff was relieved at 06:30.303

E. Pre-Investigation Intervention
__________________________________________
“[P]rior to finishing his report [of the incident], he was
instructed to simply wait within the JDG conference room,
where he was told someone would come and interview
him.”304
- Alpha Guard

__________________________________________

After the detainees‘ bodies had been found and transported, the Commander, Colonel
Bumgarner, ordered all guards involved in the incident to the JDG conference room in Building
1 at approximately 01:10.305 First, they were told to write 2823 sworn statements as mandated by
the SOPs.306 Then, they were told not to write the 2823 statements; those who had begun writing
their statements, as per the SOPs, were told to stop and go to the JDG conference room.307 Others
never began to write their statements.
The investigation does not contain any 2823 sworn statements. Based on the nature of the
incident on June 9-10, 2006, it is unclear why the Commander did not have the guards, medics,
and others involved fill out sworn statements. The SOP‘s require that 2823 sworn statements
must be made for all such incidents immediately upon the happening of the event.308

297

NCIS at 1092, 1081, 1060, 1069; see also NCIS 1079 (Guard recalling that ―[t]he admiral and some other people
came in. The admiral gathered us all up and gave a little pep talk and debrief where he praised our efforts and said
that the detainees had been trying to commit suicide for a long time‖).
298
NCIS at 1069, 1079.
299
NCIS at 1004, 1020.
300
NCIS at 1094, 1101.
301
NCIS at 1086, 1101.
302
NCIS at 1094.
303
NCIS at 1089.
304
CITF at 41.
305
CITF at 41, 45, 47; NCIS 1004, 1026. This is prior to ISN 093 being declared dead, which was stated as early as
0105 hours (CITF at 49) to as late as 0210 hours (NCIS at 1074.)
306
CITF at 41; NCIS at 944.
307
CITF at 41; NCIS at 944. The SOP that mandates this procedure is 32-1 (2004).
308
SOP 32-1 (2004).

34

__________________________________________
“I pulled three or four guards from Alpha block into my office
to find out what had happened and put together a series of
events.”309
- Colonel Bumgarner

__________________________________________

Colonel Bumgarner gathered everyone involved into the conference room.310 He then
told everyone to sit and ordered all the guards to sign a roster and to indicate with an asterisk if
they had been assigned to Alpha Block that night.311
The Commander called Alpha guards aside ―to put together the series of events.‖312 He
spoke with each Alpha Block guard for approximately four or five minutes.313 Although he
reports that he knew what each guard looked like, he did not know their names.314 While he was
certain that five people were on duty the night of June 9, 2006, ―nobody could tell [him] at that
time who walked the tier prior to discovering the first detainee.‖315
At about 02:00 hours, the Commander left the guards in the conference room so that he
could brief another officer.316 Local NCIS, CITF, and FBI representatives arrived sometime
later.317 Colonel Bumgarner briefed the representatives on what he knew and instructed all
personnel in the room to speak with NCIS.318 He then went back to Alpha Block to look at the
cells where the reported suicides occurred.319 Investigative representatives, who arrived on the
scene around the same time, subsequently interviewed some guards.320

F. Colonel Bumgarner’s and Admiral Harris’ Statements
On June 9, 2006, Colonel Bumgarner gave an interview to Fox News personality, Bill
O‘Reilly, who was at Guantánamo filming a special for his show, The O‟Reilly Factor.321 During
the course of the interview, Colonel Bumgarner painted a strikingly significant picture of Camp
Delta. He stated that he believed an Al Qaeda cell was operating from inside the camp.322 He

309

NCIS at 1061.
NCIS at 1061.
311
NCIS at 1013, 1061.
312
NCIS at 1061.
313
NCIS at 1061.
314
NCIS at 1061.
315
NCIS at 1061.
316
NCIS at 1061.
317
NCIS at 1061.
318
NCIS at 1061.
319
NCIS at 1061-62.
320
NCIS at 1061, 1017, 1020, 991, 944.
321
NCIS at 1063.
322
Col. Michael Bumgarner, Interview with Bill O‘Reilly, June 9, 2006, available at
http://www.foxnews.com/story/0,2933,199439,00.html.
310

35

affirmed that the detainees had attacked the guards previously and would attack guards again if
given the chance.323
__________________________________________
“Make no mistake bit [sic], they will cut your throat in a
heartbeat. Make no mistake about it ….”324
- Colonel Bumgarner

__________________________________________

After the alleged suicides, Colonel Bumgarner provided a statement on June 17, 2006,
recounting his and Admiral Harris‘s involvement in the night‘s events.325 In his 11-page
statement, he described his concern that the detainees were becoming more violent and the steps
taken to ensure that the guards took appropriate precautions.326
Colonel Bumgarner reports that on June 9, 2006, he spent the night at Admiral Harris‘s
home. At 00:48, the DOC called him to the Camp, and he immediately drove to the DET
Clinic, following the ambulance into the Camp.328 Before he left, however, he called Admiral
Harris to inform him that a suicide attempt had occurred.329 There was no doctor at the clinic
when he arrived; only guards and medical personnel attended to the three lifeless detainees.330
Again, Colonel Bumgarner called Admiral Harris; this time stating he believed all three were
dead.331 After the second detainee was declared dead at 01:16, Colonel Bumgarner notified the
Joint Operations Center (―JOC‖) of the deaths, and Admiral Harris arrived minutes later.332
327

Colonel Bumgarner did not know how the detainees had died but he did notice the
indentations on Al Tabi‘s and Ahmed‘s necks.333
__________________________________________
“…[T]he Admiral gave a pep talk to medical staff as they all
334
appeared very despondent....”
- Colonel Bumgarner

__________________________________________

323

Col. Michael Bumgarner, Interview with Bill O‘Reilly, June 9, 2006, available at
http://www.foxnews.com/story/0,2933,199439,00.html.
324
Col. Michael Bumgarner, Interview with Bill O‘Reilly, June 9, 2006, available at
http://www.foxnews.com/story/0,2933,199439,00.html.
325
NCIS at 1054-1064.
326
NCIS at 1063.
327
NCIS at 1059.
328
NCIS at 1059.
329
NCIS at 1059.
330
NCIS at 1059.
331
NCIS at 1059.
332
NCIS at 1060.
333
NCIS at 1060 (―While I suspected that had all been [sic] found hanging, I told the Admiral [sic] was not sure if
they had been found hanging, but I pointed out the ligature marks on each detainee, and the material that had
[REDACTED] of ISN 588…‖).
334
NCIS at 1060.

36

Colonel Bumgarner went further with his statement, including information about Camp 1,
its rules, and the detainees housed there. He discussed the relevant SOPs in place that night,
specifically describing the SOPs regulating the hanging of items in cells and prohibiting the
detainees from damaging items.335 Guards were not to allow detainees to hang items higher than
halfway up the cell or to allow detainees to damage comfort items.336
__________________________________________
“I stake my reputation and my life as a career military
policeman on this. No if, ands, or buts.” 337
- Colonel Bumgarner

__________________________________________
In the days following the deaths, the commanding officers at Guantánamo spoke with
media regarding the reported suicides. Despite the extremely high level of security at the
detention facility and the absence of an opportunity to conspire, Admiral Harris stated that the
detainees committed suicide as an act of coordinated ―asymmetric warfare‖ against the US, ―not
[as] an act of desperation.‖338 Admiral Harris explained further that ―the acts were tied to a
‗mystical‘ belief at Guantánamo that three detainees must die at the camp for all the detainees to
be released.‖339
Colleen Graffy, Deputy Assistant Secretary of State for Public Diplomacy, described the
incident as a ―good PR move to draw attention.‖340
__________________________________________
“They [the detainees] are smart. They are creative. They are
committed. They have no regard for human life, neither ours
nor their own.… I believe this was not an act of desperation,
but rather an act of asymmetrical warfare waged against
us.”341
- Admiral Harris

__________________________________________

335

NCIS at 1057.
NCIS at 1058.
337
Col. Michael Bumgarner, Interview with Bill O‘Reilly, June 9, 2006, available at
http://www.foxnews.com/story/0,2933,199439,00.html.
338
Laura Parker, Bush: Guantanamo's future up to Supreme Court, USA TODAY, June 14, 2006, available at
http://www.usatoday.com/news/washington/2006-06-14-bush-gitmo_x.htm; James Risen and Tim Golden, 3
Prisoners Commit Suicide at Guantánamo, N.Y. TIMES, June 11, 2006, available at
http://www.nytimes.com/2006/06/11/us/11gitmo.html.
339
James Risen & Tim Golden, 3 Prisoners Commit Suicide at Guantánamo, N.Y. T IMES, June 11, 2006, available
at http://www.nytimes.com/2006/06/11/us/11gitmo.html.
340
See ―Guantánamo suicides a ‗PR move,‘‖ BBC News, June 11, 2006, available at
http://news.bbc.co.uk/2/hi/americas/5069230.stm.
341
James Risen & Tim Golden, 3 Prisoners Commit Suicide at Guantánamo, N.Y. T IMES, June 11, 2006, available
at http://www.nytimes.com/2006/06/11/us/11gitmo.html.
336

37

__________________________________________
“I feel that the guards and myself on Alpha block did an
inadequate job monitoring the detainees that night to make
sure that they were following the rules….”342
- Name Redacted

__________________________________________

G. Silence
The statements from medical personnel fail to show how the three detainees died. After
the first detainee arrived at the clinic, the medics never asked what had happened or how he had
died. They failed to ask the same questions about the second and third detainees. As each
detainee arrived at the clinic, none of the guards mentioned how the detainees had died or what
had occurred. From the arrival of the first body until all three were declared dead, no medics
asked and no guards described what had happened on the cellblock that night.
__________________________________________
“…I am not sure if I walked Alpha Block or not. If I did, I do
not recall anything being out of the ordinary.”343
- Name redacted,
suspected of making false official statements

__________________________________________
1. Silence of the Medics
The medics, according to SOPs, should have responded to the cell block, but they did not.
Instead, the guards brought all three detainees to the clinic. The medics then performed CPR on
the detainees, whose mouths were locked shut and who still had makeshift ropes tied around
their necks.344 Despite all three detainees presenting with both extreme and similar conditions,
none of the medics ever asked what had happened to the detainees or how they had been
discovered.
__________________________________________
“I never heard anyone describe how the detainees were
345
found.”
- DET Clinic Medic

__________________________________________

342

NCIS at 984.
NCIS at 937.
344
NCIS at 1103, 1025, 1020, 1045.
345
NCIS at 1079.
343

38

2. Silence of the Commander
Neither the guards nor the medics advised the commanding officer about how, where or
when the detainees had died. When Colonel Bumgarner was at the DET clinic after the detainees
were declared dead, he still did not know how the detainees had died, though he did notice the
indentations on Al Tabi‘s and Ahmed‘s necks.346
__________________________________________
“I was still not sure how it [the detainees‟ deaths] had
347
happened.”
- Colonel Bumgarner

__________________________________________
3. Silence of the Detainees
The investigative files contain a total of 21 brief summaries of detainee interviews
regarding the events of June 9 and 10, 2006.348 Some detainees claimed that they slept through
the entire event;349 others reported they were asleep until awoken by the yelling and running of
the guards.350
__________________________________________
“Every detainee was alive and moving.”351
- Name redacted
“I told all the detainees to take down anything hanging and
352
woke them all up.”
- Name redacted

__________________________________________
According to the investigation, the detainee statements prove to be of limited guidance in
ascertaining what happened that night. Only 3 of the 21 statements account for seeing all three of
the deceased detainees.353 Some detainees claim to have seen only one.354 Most of the detainees

346

NCIS at 1060 (―While I suspected that had all been [sic] found hanging, I told the Admiral [sic] was not sure if
they had been found hanging, but I pointed out the ligature marks on each detainee, and the material that had
[REDACTED] of ISN 588…‖).
347
NCIS at 1060.
348
There are a total of 22 interviews (6 from the NCIS file and 16 from the CITF file); however, it is uncertain as to
whether investigators interviewed 22 different detainees or if the investigators interviewed some detainees more
than once. See Appendix F for an account of the detainee statements.
349
NCIS at 1130; CITF at 72.
350
See, e.g., NCIS at 1130–1131, 1140; see also CITF at 37, 44, 52, 54, 60, 48.
351
NCIS at 984.
352
NCIS at 966.
353
CITF at 52, 54, 70.
354
See, e.g., CITF at 58, 60, 68, 76; NCIS at 1140.

39

provided minimal information in the interviews.355 Two statements provide great detail about the
guard‘s discovery of Al Zahrani, but do not account for the discovery of the other dead detainees
moments later.356
__________________________________________
“Interviews were conducted with all detainees assigned to
alpha block, however, none of the interviewees could provide
357
any substantive information.”
- Name redacted

__________________________________________
The detainees seemed surprised by the suicides and blamed the pressures of living at the
camp under the guards‘ watch.358 One detainee ―believes the Americans are the reason for the
deaths of the three detainees.‖359 Only one statement alludes to any coordinated plan between the
detainees, claiming that 40 brothers had made a commitment to die, and ―they would see their
commitment when doing the autopsies.‖360
Most of the interviewed detainees noted that they had no prior knowledge of the suicides,
and if they had, they would have immediately informed the guards.361 In particular, one detainee
stated, ―[i]t is well known . . . that it is unlawful in Islam to kill oneself,‖ and ―it was his religious
duty to tell if he knew of a plan to harm oneself.‖362 Based on the information provided in the
investigations, there is no record that any detainee spoke up to prevent the detainees from
harming themselves.

355

See, e.g., NCIS at 1130 (stating that the detainee slept through the entire commotion); NCIS at 1131 (stating that
the detainee‘s cell was too far away to see anything); NCIS at 1134 (stating that the detainee‘s cell was too far away
to see anything); CITF at 54 (stating that the detainee responded ―I don‘t know‖ or one word answers to most of the
questions asked); CITF at 64 (stating that detainee refused to talk about the incident except for ―blam[ing] the
Americans‖); CITF at 65 (stating that the detainee awoke to the ―guards yelling at people to get out of their cells,‖
but ―was not focusing on anything at the time‖); CITF at 66 (stating that the detainee was ―woken up by guard
personnel after discovering one of the detainees (NFI) had apparently hung himself‖); CITF at 72 (stating that
detainee simply said ―nothing happened in [his] cell‖ and that he ―did not see anything‖); CITF at 75 (stating that
―[redacted] provided minimal information during the discussion, offering limited responses‖).
356
CITF at 58; CITF at 60 (―[redacted] was oblivious of the fact [that] two other detainees died.‖).
357
NCIS at 35.
358
NCIS at 1141.
359
CITF at 64.
360
NCIS at 1201.
361
NCIS at 1130; CITF at 57, 58, 60, 62, 69, 71, 75.
362
CITF at 69.

40

7. Failures of the Investigations
A. Evidence Without Findings, Findings Without Evidence
1. Evidence Without Findings
The investigations contain many pieces of evidence that are never explained or explored
further. Evidence in the report stated: (1) the detainees‘ hands and feet were bound when the
detainees were discovered;363 (2) rags were imbedded deep into their throats;364 (3) the detainees
had been dead for hours;365 and (4) the guards on duty constantly watched each of the detainees
cells and reported nothing unusual during the hours between the deaths and the discovery of the
bodies.366
Many interviews and other evidence in the investigative files support these four pieces of
information. However, each was inexplicably omitted from the conclusions of the investigation.
2. Findings Unsupported by Evidence
The government reported that the detainees committed suicide as part of a conspiracy.367
The investigations, however, fail to present any evidence of a conspiracy. In fact, all other
evidence is inconsistent with the conclusion that the detainees conspired. There are three points
in the NCIS Statement of Findings which are unsupported by evidence in the investigative files.
“Possible Suicide Notes”
The NCIS investigative file states that possible suicide notes were found on all of the
detainees‘ bodies and in their cells.368 The NCIS Statement of Findings states that the similar
wording of the notes supports the fact that the detainees conspired to commit suicide.369
However, the language in the notes is ambiguous. The NCIS investigation states that ―there is
not explicit discussion of suicide in the handwritten portion‖ of a longer suicide note found in
one detainee‘s cell.370 The shorter notes found on the bodies contain one sentence and are labeled
―possible suicide notes.‖371

363

NCIS at 950, 958, 975, 1091, 1094; CITF at 34, 44, 45.
NCIS at 938, 950, 959, 966, 975, 1073, 1079, 1091, 1093, 1097; CITF at 32, 49, 50.
365
Autopsy Report for ISN 588 at 28; Autopsy Report for ISN 693 at 19.
366
NCIS at 921, 958, 965, 974; CITF at 31, 35, 36; SJA at 33.
367
James Risen & Tim Golden, 3 Prisoners Commit Suicide at Guantánamo, N.Y. T IMES, June 11, 2006, available
at http://www.nytimes.com/2006/06/11/us/11gitmo.html. See NCIS Statement at 2.
368
NCIS at 2.
369
NCIS Statement at 1.
370
NCIS at 1372.
371
NCIS at 1239. The NCIS translates these ―suicide notes‖ to: ―I gave the Koran so they won‘t violate it. here I am
giving my body …so they don‘t violate or shame it…‖; ―I got out of the cages whether you like it or not.
Punishment for my action …They put me in Oscar isolation rooms forever‖; ―You did not except the tube on my
nose!!! So except the rope on my neck???...‖
364

41

Detainees are prohibited from passing any paper between cells,372 and empty cells
separated the three detainees from each other. Collaboration through notes would have been very
difficult if not impossible.
__________________________________________
“Representatives of other law enforcement agencies involved
in the investigation were later told that on the night in
question, another detainee (who did not later commit suicide)
had walked through the cell block telling people „tonight‟s the
373
night.‟”
- NCIS Statement of Findings

__________________________________________
Anonymous Rumor: “tonight‟s the night”
NCIS accepts as fact a statement from an unidentified law enforcement agency, quoting
an unidentified source, describing an unidentified detainee‘s statement. Its Statement of Findings
concludes that a detainee walked through the cell block informing the other detainees that
―tonight‘s the night.‖374 There is no evidence in the investigative files that this statement was
ever made. Further, detainees are not permitted to walk through the corridors of the maximum
security cell block to communicate with one another.375
__________________________________________
“…[T]here was growing concern that someone within the
Camp Delta population was directing detainees to commit
376
suicide….”
- NCIS Statement of Findings

__________________________________________
Camp Delta Suicide Director
The NCIS Statement of Findings asserts that ―there was a growing concern that someone
within the Camp Delta population was directing detainees to commit suicide.‖377 The
investigative files fail to reveal who had this concern or the basis for it. There is no evidence that
any steps were taken by officers or guards to identify which detainee was directing others to
commit suicide. In fact, the investigative files contain no evidence of any detainee directing or
coordinating suicides. Nor is there any evidence of enhanced security measures to address this
reportedly ―growing concern.‖

372

SOP 8-7 (m) (2) (2004).
NCIS Statement at 1-2.
374
NCIS Statement at 1-2.
375
SOP 11-1 (d) (2004) (Escort Operations); SOP 10-7 (a) (2004) (Showers and Laundry); 10-6 (c) (3) (c) (2004)
(Exercise).
376
NCIS Statement at 1.
377
NCIS Statement at 1.
373

42

Lack of Documentation
There are no documents, statements, video surveillances, log-book notes, DIMS reports,
or other records that suggests a coordinated act. No guard was questioned about how the
detainees could have communicated to conspire or coordinate their elaborate acts while under
constant surveillance.
__________________________________________
“The majority of the items [pieces of paper] were reviewed
with only twelve (12) documents of potential evidentiary value
378
being seized.”
- NCIS Investigative File

__________________________________________
The investigation collected and reviewed 1,065 pounds of paper379 and other means of
communication, but none of it indicated that the dead men conspired to coordinate their deaths in
the camp. A total of 12 documents were found to be of ―potential evidentiary value.‖380 There is
no indication which 12 papers were of interest or what information these 12 pages contained.
The NCIS Statement of Findings, however, did not mention those 12 documents, indicating that
they did not provide any valuable evidence that the three men coordinated suicides or conspired
in an act of ―asymmetrical warfare.‖381
__________________________________________
“No information relating to future acts of imminent violence
382
or threats to national security were found.”
- NCIS Investigative File

__________________________________________
Evidence Inconsistent with Conspiracy
The investigation fails to mention that Al Tabi was cleared for transfer to his native Saudi
Arabia and scheduled to leave Guantánamo before the end of the month.383 Additionally, Ahmed
was not brought to the cell block until 72 hours before his death,384 which would seem to reduce
his opportunity to conspire.

378

NCIS at 62.
This equals more than 50,000 pages of material. NCIS at 69.
380
NCIS at 26.
381
See NCIS Statement.
382
NCIS at 70.
383
Gitmo Detainee Was Cleared for Transfer before Suicide, ST. PETERSBURG TIMES, June 12, 2006, available at
http://www.sptimes.com/2006/06/12/Worldandnation/Gitmo_detainee_was_cl.shtml.
384
"Transfer off [redacted] to a transition out-patient) BLOCK"; typed statement with portion struck through by
hand, followed by handwritten statement: "non-feeding block per DOC." Dickstein Medical Files, Redacted 1272,
available at http://www.dod.mil/pubs/foi/detainees/death_investigation/DicksteinMedicalFilesRedacted-2.pdf .
379

43

Although the three men were in the same cell block, they were not in adjacent cells and
were separated by empty cells, making it difficult to communicate.385 Only the SJA report
includes any information regarding the set up of Alpha Block, which housed 28 detainees who
were supervised by five guards.386 All three detainees were housed on the same side of the cell
block in cells A-5, A-8 and A-12.387 Two vacant cells separated A-5 from A-8.388 One vacant
cell and two occupied cells separated A-8 from A-12.389
__________________________________________
“[T]he detainees are not allowed to talk to each other.”390
- Name Redacted

__________________________________________
The investigative file contains no evidence of either oral or written communications
between the three detainees or any others or any evidence to show how the three would be able
to coordinate all the necessary preparations for committing suicide simultaneously.

B. Defective Interviews
The investigations rely upon information provided in interviews and statements from a
wide variety of guards, escorts, medical personnel, and officers on duty that night. However, the
investigation does not determine which guards were responsible for failing to notice suspicious
activity that led to the deaths of the three detainees. The interviews of the Alpha guards do not
systematically review the events of the night or provide information regarding the most
troublesome problems.
1. Tainted Interviews: Commanding Officer
Immediately after the first detainees were declared dead, the Commander gathered
everyone involved that evening.391 At the meeting in the conference room, he ordered all the
guards to sign a roster and to indicate with an asterisk if they had been assigned to Alpha Block
that night.392 Then the Commander brought three or four of the Alpha guards aside to put
together ―the series of events,‖ and he spoke with each of them for approximately four or five
minutes.393 He took no notes and did not record the names of those with whom he spoke. He
said that he thought that he could recognize their faces but that he did not know their names.394
There is no record of what was said at this meeting, and neither the Commander nor the guards
were ever asked what took place at this meeting.
385

SJA at 11.
SJA at 12; CITF at 36.
387
SJA at 11.
388
SJA at 11.
389
SJA at 11.
390
NCIS at 732.
391
NCIS at 1061.
392
NCIS at 1013, 1061.
393
NCIS at 1061.
394
NCIS at 1061.
386

44

2. Investigating Officers Unable to Identify Those Responsible for the
Detainees’ Ability to Commit Suicide
Another defect in the investigations is the failure to determine which personnel were
responsible for the detainees‘ ability to commit suicide.




The Investigating Officer was never able to determine which guard or guards were
responsible for the detainees‘ ability to commit suicide without being seen.395
The Commander reported that he could not determine who had been walking Alpha
Block that night just prior to finding the first detainee hanging.396
NCIS could not determine which guards were responsible for the detainees‘ ability to
complete the steps necessary to commit suicide in the manner described without
being detected.397

While no investigative body could determine which guards were responsible for the
detainees who died that night, there were only seven people who were assigned to guard them:
the Alpha guards, the NCO and the PL.
3. Superficial Guard Interviews
The investigations did not include systematic interviews of any of guards who were or
should have been on duty that night during the time leading up to the detainees‘ deaths. While
CITF interviewed four Alpha guards in the hours after the deaths, the interviews—which an
investigator wrote to recount the guards‘ statements—contain little information regarding what
each saw and did before the discovery of the bodies.398 Those four guards did not give more
detailed first-person accounts of what happened until four or five days later.399 The PL, however,
was not interviewed at all on June 10, and did not provide any statement until four days after the
incident.400 Additionally, the June 10 interview of the Alpha NCO was only a paragraph long,
written by the interviewer, and contains no information regarding the events leading up to the
discovery of the bodies, despite the NCO‘s presence on the block throughout the evening.401 The
NCO did not provide a first-person statement until five days later.402
It is unclear why the investigators would not try to obtain more information from the
seven key persons sooner, as these individuals were in the best position to provide information
necessary to the investigation. The interviews did not provide detailed information as to what the
guards observed about the detainees and the other guards that evening. There was no systematic
attempt to reconstruct what each guard experienced from the time that he or she came on duty
until the bodies arrived at the clinic to show how suicides could have occurred on the block.
395

SJA at 4-5.
NCIS at 1061.
397
See NCIS Statement.
398
CITF at 953, 961, 968, 978.
399
NCIS at 957, 964, 973, 982.
400
NCIS at 936.
401
NCIS at 948-950.
402
NCIS at 948.
396

45

__________________________________________
“The possibility that the now deceased detainees were in fact
403
alive at 2300 on 9 June 2006, cannot be ruled out.”
- Admiral Harris

__________________________________________
4. Unasked Questions
The interviewers did not ask the guards or other personnel specific questions about
evidence obtained during the investigation. Specifically, those interviewed were not asked:







If he or she had observed the detainees hanging in their cells or what would have
prevented the guard from seeing three dead bodies hanging for two hours
If he or she noticed the blankets hanging up in the cells,404 and if so, why he or she
did not inquire about them
If he or she had observed detainees tearing up or braiding cloth, or preparing
mannequins in their bunks
How and where the detainees each obtained sufficient amounts of cloth to hang up to
block the guards‘ vision and to braid nooses and other bindings
How and where the detainees each obtained sufficient amounts of comfort items
necessary to make mannequins that looked sufficiently life-like to deceive the guards
into believing that the detainees were asleep in their beds
If he or she observed any note-passing between the detainees or heard any
communications between the detainees that night or previously
5. Interrupted Investigation: Afternoon of June 10 to June 14

The local NCIS and CITF investigators conducted some interviews on June 10, but they
are written in the third person, unsigned, and do not take the form of official sworn statements.
The Miami NCIS investigative team was flown in on the afternoon of June 10, but there is no
record of any investigative action taken by the investigative team until June 14. Further, the
NCIS investigative file does not explain the gap between the last interview on June 20 and the
next interview on July 11.
There is no evidence of any investigation by any other investigative body, including local
CITF, during the period of June 11-13, 2006.405 NCIS conducted interviews and collected
statements from June 14-17, with several follow-ups later in July. The later statements contained

403

SJA at 2.
One guard did notice that Al Zahrani had a blanket hanging up covering part of his cell at 20:30, but the
statement contains no further information as to why the guard did not ask the detainee to take them down as it
blocked the view part of the cell. See NCIS 964.
405
The SOUTHCOM file contains two interviews dated June 12, 2006 from the Department of the Navy. While
these interviews contain handwritten page numbers indicating they belong in the combined investigative file, the
interviews were not conducted by NCIS or CITF officials. SOUTHCOM at 525-529.
404

46

in the NCIS file are first-person narratives of the events of that night and include some
information of what happened before discovery of the three men, how they were discovered, and
some of the events that occurred in the hours thereafter.406
6. Questionable Framing of the Interviews and Statements
There is reason to suspect that the interviewers designed questions to obtain particular
results. The interviewers failed to frame their inquiries neutrally. For example, the PL stated that
he did not remember if he had walked the cell block that night. An interviewer advised him that
other guards had said that the Platoon Leader had walked the block that night; the PL said he still
could not remember doing so, but ―he said he would ‗go with‘ that account, if that was what the
others remembered.‖407
__________________________________________
“[Redacted] maintained that he still could not remember [if
he had walked the block]. … He then admitted to walking all
408
the way to the end of A-Block and back.”
- Name Redacted

__________________________________________
Additionally, the guards‘ first-person narratives often describe what they did not see.
Instead of describing the scene, they explicitly state what they did not notice. For instance, one
guard explains, ―I did not see anything in his mouth.‖409 Another states, ―I do not remember any
bindings around his ankles.‖410 This suggests that the investigators (or others) had directed the
guards‘ attention to those questions. While these types of questions are acceptable, they are
appropriate only after the interviewer has first elicited the interviewee‘s complete recollections.

C. False Statements
As of June 14, 2006, all four Alpha guards assigned to Alpha Block that night, the Alpha
Block NCO, and the Alpha Block PL were informed that he or she was suspected of making
false official statements and/or failing to obey direct orders.411 There is no evidence of the
contents of these statements, what they were, or the time and place they were made. The
investigation does not indicate what prompted the suspected false statements and failures to obey
direct orders. No evidence of any disciplinary action taken as a result of these false statements
exists.

406

See Table 1.
NCIS at 940.
408
NCIS at 940.
409
NCIS at 1004.
410
NCIS at 975.
411
NCIS at 935, 947, 956, 963, 972, 981.
407

47

Each guard was advised to sign the following:
1. I have the right to remain silent and make no statement at all;
2. Any statement I make can be used against in me in a trial by a court-martial or other
judicial or administrative proceeding;
3. I have the right to consult with a lawyer prior to any questioning. This lawyer may be
a civilian lawyer retained by me at no cost to the United States, a military lawyer
appointed to act as my counsel at no cost to me, or both;
4. I have the right to have my retained lawyer and/or appointed military lawyer present
during this interview; and
5. I may terminate this interview at any time, for any reason.412
If convicted of making a false statement under the Uniform Code of Military Justice, a
person ―shall be punished as a court-martial may direct,‖413 which can include reprimand, fines,
forfeiture of pay and allowances, demotion, restriction to confined limits, hard labor without
confinement, confinement with hard labor, and punitive separation, including dishonorable
discharge.414
Several of the guards‘ interviews appear in consecutive pages as a set. ―Military Suspect‘s
Acknowledgement and Waiver of Rights‖ forms are included with six statements of guards who
were on Alpha block that night.415 This form appears before each of their respective ―sets‖ of
interviews and is signed by the designee.416 The four Alpha Block guards signed these waivers
the same day that they made the first statements included in the report—June 14 or 15. Thus, it
appears that the suspected false statements were made sometime before June 14 or 15.
Table 3: Waiver Statements417
“Military Suspect’s Acknowledgement and
GUARD
Waiver of Rights” Accusation
When Signed
―I am suspected of False official Statement
Signed the same day as
AG1
Article 107, and Failure to obey an order or
written narrative.
regulation Article 92.‖
Signed one day before
―I am suspected of failure to obey a direct
AG2
written narrative.
order.‖
AG3

―I am suspected of providing a false official
statement.‖

Signed the same day as
written narrative.

AG4

―I am suspected of False official statements,
UCMJ Article 107.‖

Signed the same day as
written narrative.

412

NCIS at 935, 947, 956, 963, 972, 981.
U.C.M.J. § 107 (10 U.S.C.S. § 907).
414
Rules of Courts Martial § 1003, (Manual for Courts-Martial 2008).
415
NCIS at 935, 947, 956, 963, 972, 981.
416
See Table 1 below.
417
See Appendix L.
413

48

Alpha NCO

―I am suspected of False Official Statements,
UCMJ Article 107.‖

Camp 1
Platoon
Leader

―I am suspected of FALSE OFFICIAL
STATEMENT.‖

Signed the same day as
written narrative.
Signed one day after June
14 interview. Signed a
second time on June 16
during a re-interrogation,
which is subsequently dated
June 17.

D. Missing Evidence
The investigators conducted many interviews to gather information. The report, however,
does not include:










Sworn statements on required forms
Serious Incident Reports
Surveillance video
Audio recordings
Duty roster
Detainee transfer book
Pass-on book
DIMS system information
Statements from additional witnesses, including tower guards
1. Missing Sworn Statements

The SOPs require all personnel involved in incidents to write sworn statements (DA 2823
form). Initially, some of those involved in the incident were asked to do so. No sworn
statements were available for the NCIS investigators, however, because personnel were then
ordered to stop writing them.419 No explanation was given as to why they were ordered not to
follow this standard procedure. The investigative file does not comment on this or contain the
partial statements.
418

418

See NCIS at 944, 1086, CITF at 41; SOP 32-1 (e)(10) (2004); SOP 6-15 (d)(2)(2004). (DA Form 2823 is a sworn
statement in which the person completing it recounts exactly what occurred during the reported incident.).
419
NCIS at 944, 1086; CITF at 41.

49

__________________________________________
“[Redacted] continued to explain that once roll call was
complete, he was advised to report to the JDG office wherein
he would prepare a report of the incident. [Redacted] said
however that prior to finishing his report, he was instructed to
simply wait within the JDG conference room, where he was
told someone would interview him.” 420
- Redacted name

__________________________________________
2. Missing Surveillance Video and Audio Recordings
NCIS was provided all videotapes on or about June 13, 2006, but there is no mention that
NCIS reviewed them.421 It is clear from a statement by Rear Admiral Mark H. Buzby that
hallway and common area video monitoring at Guantánamo is standard practice.422 A
memorandum dated June 15, 2006, confirms that SOUTHCOM delivered ―a videotape of the
events of 10 Jun 06.…The video is the only tape the command holds relating to the events under
investigation.‖423 Aside from the two memoranda in the SOUTHCOM file that mention delivery
of the videotapes to NCIS, the government never refers to any videos in the investigative
documents.
Further, audio recordings of the radio and telephone calls were not reviewed.424 Despite
reviewing the June 9 DIMS headcounts recorded in the system, NCIS could not determine which
guard made the headcounts.425
3. Missing Duty Roster, Detainee Transfer Book, and Pass-on Book
At Camp Delta, successful operation depends on accountability. ―Supervisors must know
where assigned detainees are and what they are doing at all times.‖426 Everything that occurs
must be documented by the guards, including: suspicious activity, meal consumption, missing or
damaged equipment, detainee behavior, detainees‘ attempts to harm themselves, headcount
times, headcount performers, instances when guards randomly walk the block together, instances
420

CITF at 44.
SOUTHCOM at 837.
422
White, Josh. Defendants' Lawyers Fear Loss of Potential Evidence at Guantanamo Bay. THE WASHINGTON
POST. February 14, 2008, available at http://www.washingtonpost.com/wpdyn/content/article/2008/02/13/AR2008021303164.html (―Buzby's declaration, filed in federal cases Friday and
yesterday, said the video recordings were part of a surveillance system used to monitor the camps and were mostly
of mundane operations.‖)
423
SOUTHCOM at 839.
424
The Dictaphone recording system, which records emergency calls throughout the camp, was reported to have
been inactive and not available for the investigators to review. NCIS at 926 (―Reporting Investigator and [name
redacted] logged into the Dictaphone recording system and discovered it had experienced a power failure and had
not been properly reactivated. Because the Dictaphone was deactivated, it did not record any calls from 03MAY06
until about 2100 on 10JUN06, when power was restored during maintenance.‖).
425
NCIS at 952, 977.
426
SJA at 19-20.
421

50

when a search is conducted, instances when a response team is called, or when any major
incident occurs.427 Most of this information was not reviewed.
A duty roster listing every shift of all guards on Alpha Block and elsewhere is required
and must be maintained.428 That night, instead of looking to the duty roster, the Commander
asked those guards who were on Alpha Block to place an asterisk next to their names.429 No duty
roster was subsequently produced in the investigative file.
While NCIS investigators did look into the log book from that night, which documented
the entry and exit of persons from the block, a page from June 10, 2006 had been removed from
the book.430 Although this was noted and the book was seized, questions remain as to who had
entered Alpha Block during the undocumented time period on June 10.
Additionally, the investigations did not address or reproduce the pass-on book for Alpha
Block for that day or night. All activity must be noted in the pass-on book, which is passed from
one shift to the next to provide information of the prior happenings on the block.431
All data and documentation regarding the detainees and the cell blocks is also entered
into the DIMS. ―All documentation needs to answer Who, What, When, Where, Why, and
How.‖432 To ensure that the Block NCO knows the total number of detainees on the cell block
and their ISNs when he or she is assuming his or her shift, the guards must complete the
Detainee Alpha Roster and enter it into the DIMS.433 This further verifies that the Block NCO
knows exactly which detainees he or she is responsible for during his or her shift.434
The roster of detainee location for that night, however, was not investigated, addressed,
or provided in the file to determine whether or not the deceased detainees may have been
removed from their cells at some time during the day or night.435
4. Missing Witnesses
Many guards, escort control, medical personnel, and officers on duty that night were
interviewed. The investigation does not contain any interviews, however, with any personnel in
the Detainee Operations Center or in the nearby guard towers who had visual access into each
camp.436 Only one member of the IRF team, one Sally guard, and few guards from other blocks
who saw bodies were interviewed or asked to make a statement. The investigators did not

427

SOP 6-15 (2004).
SOP 36-6 (c) (6); (10) (2004).
429
NCIS at 1013.
430
NCIS at 1354.
431
SOP 33-6 (e) (15) (2004).
432
SOP 6-15 (a) (2004).
433
SOP 6-15 (d) (7) (2004).
434
SOP 6-15 (d) (7) (2004).
435
SOP 5-8 (b) (2004) (A roster binder is kept on the block.).
436
SJA at 19-20.
428

51

interview any of the guards recalled to the camp for their observations of the detainees on Alpha
block in the aftermath of the incident.
5. Missing Serious Incident Reports
According to SOPs, Serious Incident Reports are used when an event occurs that requires
the use of force, such as a cell extraction or in cases of attempted suicides.437 The Commander
will complete the Serious Incident Report and will forward it to the CJDOG.438 These would
have been required for June 9 and June 10. The investigative file does not contain any record of
Serious Incidents Reports despite SOPs mandating this procedure.

E. Impenetrable Presentation
The way in which the investigative files are presented makes it difficult to understand
how the investigation was conducted. It produced more than 1,700 pages of interviews and
information regarding the events of June 9 and 10, but the evidence obtained as presented is
virtually impenetrable.439 Pages are missing, paragraphs are redacted, and documents with
information are disorganized, making it difficult to review any of the evidence obtained through
the investigations.
Over one third (35.8 percent) of the pages are fully redacted, and another 22.7 percent has
more than half of its information redacted. In fact, only 13.3 percent of the pages have not been
redacted at all, and of that number, 47 pages are Deleted Page Information Sheets (―DPIS‖).440
Some of the DPIS pages refer to documents not released by the DOD. The NCIS investigative
file contains only handwritten page numbers, but where pages are missing, a DPIS alerts the
reader to sections of the text that must be obtained from another file. These sheets indicate that
the NCIS, CITF, and SOUTHCOM investigative files are meant to fit together into one
combined investigative document.
The CITF and SOUTHCOM documents all contain typed page numbers appearing at the
bottom of each individual document. Some of the pages in those files also contain different
handwritten page numbers, similar to those on the NCIS investigative file, next to the typed page
numbers. The handwritten page numbers range from 1 to 1,426, and when all the pages are
combined and in order, the document becomes one complete investigative document that
includes sections from all three separate investigations.
The order of the pages hinders the reader in understanding the events of that night. There
is no table of contents, no index, and no indication that the last page is the end of the
investigative file. While all written page numbers are accounted for by the DPIS pages, it is
impossible to locate those pages in the other investigative files due to the large number of fully

437

SOP 5-7 (a) (2004).
SOP 5-7 (b) (2004).
439
This includes the NCIS, CITF, SOUTHCOM, SJA reports, and the AFME autopsies for the three detainees.
440
See Table 5, Appendix J.
438

52

redacted pages in those documents.441 Some DPIS sheets refer to documents unreleased by the
DOD, including information from the Armed Forces Medical Examiner.442 A few refer to
documents from the Federal Bureau of Investigation, which the military does not have the
authority to release.443

F. No Disciplinary Action Recommended Despite SOP Violations
__________________________________________
“…[D]isciplinary action is not warranted in this case.” 444
- Admiral Harris

__________________________________________
Six weeks after the incident, Admiral Harris appointed an independent Investigating
Officer to conduct an additional investigation to determine whether any guards violated SOPs
before, during, and after the detainee deaths.445 As a result, Admiral Harris determined that no
disciplinary action would be or should be instituted against the guards who were responsible for
the detainees during the hours before they were discovered dead.446 Admiral Harris did concede,
however, that several SOP violations occurred that night.447
It took three months to complete the investigation.448 The report was finally released a
year and a half later on or about April 28, 2009.449

441

For example, one DPIS sheet on page refers the reader to ―Page(s) 478-727 Enclosures (A)-(B)‖ and states
―Referred to SOUTHCOM‖ under the ―Comments‖ lines on the page. However, the SOUTHCOM document does
not contain any pages with those handwritten page numbers. Because there are so many fully redacted pages in the
document, it is possible that these pages have been redacted.
442
See DPIS in NCIS for 190-219, 736-769, 771-792, 795-829, 1105-1107, 1110-1112, 1114-1118, 1386-1391.
443
See DPIS in NCIS for 17-24, 72-158, 1132-33, 1135-36, 1154-68, and 1171-1200.
444
SJA at 5.
445
SJA at 1.
446
SJA at 2.
447
SJA at 1-3.
448
See SJA at 1–3. The investigation was completed on September 6, 2006. It began on July 20, 2006.
449
See The Office of the Secretary of Defense and Joint Staff Reading Room,
http://www.dod.mil/pubs/foi/recent.html.

53

CONCLUSION
On June 10, 2006, three men died under questionable circumstances. The investigation
into their deaths resulted in more questions than answers. It is unclear how such a reputable
investigative service produced such an incompetent investigation. The Center for Policy and
Research is unable to resolve whether the facts led to the investigation or the investigation led to
the facts. What is clear is that the true circumstances surrounding the detainees‘ deaths cannot be
discerned from the investigative file or the statement of findings. Without a proper investigation,
it is impossible to determine the circumstances of three detainees‘ deaths.

54




APPENDICES
to

Death in Camp Delta

A- 1



TABLE OF CONTENTS
A. Dates of Statements and Interviews...........................................................................................3

B. Maps of Camp Delta....................................................................................................................9

C. Pictures from the Department of Defense.............................................................................. 11

D. Admiral Harris’ Conclusions................................................................................................... 15

E. Discovery of the Detainees – Individual Guard Accounts................................................... 16

F. Information from Escort Statements in NCIS report (By page numbers).......................... 20

G. Details of the Detainee Statements during the NCIS and CITF Investigation .................. 28

H. False
Statement
and
Failure
to
Obey
Direct
Orders......................................................... 31

I.

Discount of the NCIS Statement on Detainee Suicides ....................................................... 38


J.

Missing and Redacted Pages ................................................................................................... 43


K. Staff Log and Sworn Statement Forms for GTMO Detention Center Staff ...................... 47

L. The Men Who Died .................................................................................................................. 49

M. Detainee Comfort Items .......................................................................................................... 51

N. List Of Authorized/Unauthorized Activities As Per The 2004 SOPs................................. 52

O. Physical Descriptions of Signs of Death................................................................................ 53

P. Binding Descriptions ................................................................................................................ 68

Q. Possible Suicide Notes ............................................................................................................. 78


A- 2




Appendix A

Dates of Statements and Interviews
Statements were matched according to identifying facts that appeared in similar
statements in the NCIS and CITF files. Patterns were found in the way the statements were
grouped in the larger NCIS file according to the handwritten page numbers. The statements for
each guard appear primarily in consecutive page numbers. The type of guard was redacted from
most statements but could be discerned from the actions and statements of the individual being
interviewed. All page numbers refer to the handwritten numbers at the bottom of each page.
Table 1: Guards Statements and Interviews by Page Number
Type of Guard
June 10 June 14-17
Later
NCIS
NCIS 1st
June/July
Person
NCIS (3rd
Written
person
Account
statement)
Alpha Guard (MA)
957* (June 15)
Alpha Guard (woman)
964* (June 15)
Alpha Guard
973* (June 14)
977 (June 16)
Alpha Guard
982* (June 14)
986 (June 17),
185 (July 20),
188 (July 20
or 21)
SALLY guard (MA,
1006
1007 (June 14)
woman)
Guard (Fox?)
1031 (June 14)
Guard (IRF)
1038 (June 14)
Camp 1 Platoon Leader
936* (June 14)
940* (June
17)
Sergeant of
941
942 (June 14)
Guard/NCO
Alpha Guard (NCO)
946
948* (June 15)
952 (June 17)
Guard (Camp 1, not
987
989 (June 14)
Alpha)
Alpha Guard (day shift)
993 (June 15)
Escort Control (LPO –
996 (June 17)
998 (date
nd
2 squad)
unknown)

June
10
CITF

Name used
in this
report

953
961
968
978

AG 1
AG 2
AG 3
AG 4

Sally Guard
1029
1036

Guard 1
IRF Guard
PL
SOG
Alpha NCO
Guard 2
Escort
Control 1
A- 3



Escort Control (LPO –
1st squad)
Echo Guard
Escort Control
(woman)
Escort Control

1002

1003 (June 14)

1014

1011 (June 15)
1015 (June 15)

Escort Control
(woman)
Officer
Guard (Camp 1, not
Alpha)
Escort Control

1000/10
21

1019 (June 15)
1023 (June 14)
1034 (June 14)
1042 (June 15)

1028 (June
17)
1041

1044 (June
19**)

Escort Control
Commander (Colonel
Bumgarner)
Officer

1009

1099 (June
19)
1054 (June 17)

Escort
Control 2
Echo Guard
Escort
Control 3
Escort
Control 4
Escort
Control 5
Officer 1
Guard 3
Escort
Control 6
Escort
Control 7
Commander

1101 (June
19**)
* indicates these interviews are preceded by a Military Suspect’s Acknowledgment and Waiver
of Rights (See, supra, section 7, A)
**Interview is later than the dates June 14-17 when most 1st person written statements were
written but still is in 1st person narrative form.
NOTE: Interviews on page 940 (June 10th interview of guard who had trouble remembering
when and if he was on the tier that night) and 732 (July 11 interview of a guard who came on
duty after the events) contained little information and were not added to the list.

A- 4



Table 2: Medic Statements and Interviews by Page Number
Type of Medic
June 10 June 14-17
Later
June 10
Name
st
NCIS
NCIS 1
June/July
CITF*** used in
Person
NCIS (3rd
this
Written
person
report
Account
statement)
Nurse, Behavioral
184
Health Unit, camp
(June 20**)
hospital, Joint Task
Force
Redacted, administered
1068
medication
(June 16)
Nurse, supervised
1070
corpsmen
(June 15)
Nurse, camp hospital
1073
(June 15)
Corpsman, Third Class,
1075
administered
(June 16)
medication, clinic, Joint
Task Force
Night Shift Team
1077
Leader, clinic
(June 16)
Redacted
1081
(June 16)
Corpsman,
1083
administered
(June 16)
medication
Corpsman,
1088
administered
(June 16)
medication, Joint Task
Force
Corpsman, hospital,
1090
Joint Task Force
(June 16)
Nurse, prepared
1093
medication, clinic, Joint
(June 16)
Task Force
Redacted
1097
(June 16)
EMT
1103
EMT
1108
(June 15)
**Interview is later than the dates June 14-17 when most 1st person written statements were
written but still is in 1st person narrative form.

A- 5



***The CITF file contains 7 short summaries of interviews with medical personnel; however,
because the summaries contain very little detain and because the names are redacted, the Center
was unable to determine if the personnel interviewed by CITF were also interviewed by NCIS.
Chart 1: Number of interviews conducted by NCIS and CITF per day
Date
6/10/06
6/14/06
6/15/06
6/16/06
6/17/06
6/19/06
7/12/06
TOTAL

# of interviews/day
9
11
12
12
2
5
2
53

Number of Interviews Per Day
14
12
10
8
6
4
2
0

A- 6



Chart 2: Number of Personnel who Reported Themselves at Specific Locations*
* Based on the first-person written statements

Personnel Per Location
Hospital
Ambulance
Not Present
Location

Location
Alpha Block
Clinic
Hospital
Ambulance
TOTAL

Number of
Personal
Accounts Per
Location
20
26
4
2
52

At Clinic
Transported 693 to Clinic
Transported 588 to Clinic
Transported 093 to Clinic
Alpha Block
0

5

10

15

20

25

30

35

Number of Personnel

Chart 3: Number of Personnel who wrote First-Person Statements
Number of
Statements
12
18
5
1
36

Number of First-Person
Statements
Type of Personnel

Type of
Personnel
Medical
Guard and Escort
Control
Officers
Other
TOTAL

Other
Officers
Guard and Escort Control
Medical
0

5

10

15

20

Number of Statements

A- 7



Chart 4: Number of Interviews and Statements by Each Type of Personnel*
*This does not indicate how many personnel were interviewed as some personnel were
interviewed more than once.
NCIS Statements

CITF Statements
Number of
Statements
3
16

Type of Personnel
Other
Medical
Guard and Escort
Control
Officers
Detainees
TOTAL

Number of
Statements
0
8

Type of Personnel
Other
Medical
Guard and Escort
Control
Officers
Detainees
TOTAL

36
6
6
67

7
0
16
31

Combined Interviews of All Personnel
60
55

50

47

30

19

20

10

8

6

4
1

3

2

5

5

5
2

1

1

1

1

D

EMTs

Doctors
Night Shift
Team
Civilians
Commande
rs
REDACTE

Interviews

Nurses

Corpsmen

ERF

Escorts

Guards

NCO

SOG

MAs

CITF

0
Total
Interviews
NCIS

Number of Interviews

40

A- 8




Appendix B

Maps of Camp Delta

"Camp Delta Standard Operating Procedures," U.S. Department of Defense, Joint Task ForceGuantanamo, March 28, 2003.

A- 9



Camp Delta

Google Maps, http://maps.google.com/?ie=UTF8&ll=19.902415,75.102035&spn=0.004055,0.009645&t=k&z=17

A- 10




Appendix C

Pictures from the Department of Defense
The Department of Defense released several photographs from Camp Delta taken April 5,
2006 by U.S. Army Sgt. Sara Wood. Although the location of the cells is unknown, including
from which block they are taken, the pictures provide insight into what the cells, cell-block, and
other areas of camp look like. It is unknown whether the any of the cells in the following pictures
resemble or are actual cells from Alpha Block.

“The cell of a non-compliant detainee at Camp Delta, Naval Station Guantanamo Bay, Cuba.”
http://www.defense.gov/home/features/gitmo/images/finals/cell1.jpg

A- 11




“The cell of a compliant detainee at
Camp Delta, Naval Station Guantanamo
Bay, Cuba. All detainees get a copy of
the Koran, and compliant detainees are
given extra comfort items, such as games
and an exercise mat.”
http://www.defenselink.mil/home/feature
s/gitmo/images/finals/cell5.jpg





“The cell block on a typical ward in Camp Delta, Naval Station Guantanamo Bay, Cuba.”
http://www.defense.gov/home/features/gitmo/images/finals/cellblock.jpg

A- 12




“The door of a cell at Camp Delta, Naval
Station Guantanamo Bay, Cuba. An opening
at the top of the cell lets guards pass things to
detainees, and openings at the bottom allow
guards to shackle detainees’ feet before
transporting them.”
http://www.defense.gov/home/features/gitmo
/images/finals/celldoor.jpg



A- 13




“One of the new guard towers being used
at Camp Delta, Naval Station
Guantanamo Bay, Cuba. The new towers
move up and down on a motor and are
air-conditioned.”
http://www.defense.gov/home/features/gi
tmo/images/finals/tower.jpg



“The operating room in the detainee medical facility in Camp Delta, Naval Station Guantanamo
Bay, Cuba.” http://www.defense.gov/home/features/gitmo/images/finals/med3.jpg
A- 14




Appendix D

Admiral Harris’ Conclusions
Admiral Harris wrote out his findings after the SJA Report was completed. Specifically, those
findings were (SJA 1-2):
1. Admiral Harris accepted that the violation of [redacted SOP(s)] contributed nothing to the
ability of the detainees to commit suicide.
2. Admiral Harris rejected the conclusion that the violation of the SOP regarding guard coverage
contributed nothing to the detainees’ deaths. Instead, he concluded that the uninterrupted gap in
guard coverage on the tier may have contributed to the detainees’ suicide preparation.
3. Admiral Harris accepted that the violation of [redacted SOP(s)] contributed nothing to the
detainees’ ability to commit suicide. However, Admiral Harris concluded that this violation was
not insignificant. Admiral Harris directed the JDG to institute procedures to “ensure
accountability in this process in the future.”
4. Admiral Harris rejected the investigator’s underlying conclusion. Admiral Harris found that
the SOP violation regarding head counts could not be ruled out as contributing to the ability of
the detainees to commit suicide.
5. Admiral Harris accepted that the violations of [redacted SOP(s)] and [redacted SOP(s)]
potentially contributed to the ability of the detainees to commit suicide; however, he found that it
is possible that the detainees could have successfully committed suicide even in the absence of
any violations.

A- 15




Appendix E

Discovery of the Detainees – Individual Guard Accounts
EVENT
Finding of
Detainee 093 in
Cell A-8

ACTOR/PAGE #
Alpha Guard #1
(NCIS 957, CITF 953)

ACTIONS
•
•
•
•
•
•
•
•
•
•

•
•
•
•
•
•
Alpha Guard #2
(NCIS 964, CITF 961)

•
•
•
•
•
•
•
•
•
•

Alpha Guard 1 (AG1) noticed
something suspicious with A-8
during his shift
AG1 left Alpha Block and went into
the NCO’s office to get ____ 1
AG1 asked ____ to come look at
something suspicious in cell A-8
AG1 witnessed what appeared to be a
small torso under a blanket
AG1 called to A-8, but receive no
response
AG1 and ____ both went back to the
NCO’s office and told the NCO ____
AG1 went to the guard shack to get
____
____ started calling for A-8 to wake
up
The detainees were saying “Shut up,
shut up”
____ reached into bean hole and
grabbed blanket, pulled, but still
received no response
We opened and entered A-8
Detainee was hanging from twisted
sheet
AG1 cut the detainee down
AG1 removed stuff from his face
All three guards placed 0093 on
backboard
All three guards took him to medical
unit
AG2 was in the guard shack
____ came in and alerted us to the
problems
AG2 ran to A-8
____ pounded on the door to get the
detainees attention
____ opened bean hole
AG2 opened “vacant cell” A-7
____ pushed sheet aside and saw him
hanging
AG2 unlocked A-8
HUNT cut braided rope made from
sheets
Detainee was carried out, placed on

OBSERVATIONS
•
•

•
•

•
•
•
•

Wad of white sheet
crammed in his
mouth
Tightly wrapped
sheet around his
neck and face
Blue fingertips
The rest of the
detainees on the cell
block went crazy
and became loud

Urine spots
Blue fingers
Eyes wide open
Cool to touch


























































1

“_____” indicates redacted information.

A- 16



•
•
Alpha Guard #3
(NCIS 973, CITF 968)

•
•
•
•
•
•
•
•
•

•
•
Alpha Guard #4
(NCIS 982, CITF 978)

•
•
•

Alpha Block Sergeant
of the Guard – SOG
(NCIS 942)
Alpha Block NCO
(NCIS 946, 948)

•
•
•
•
•
•
•
•
•
•
•

•

Alpha Block Platoon
Leader

•

deck in tier
Saw that ____ was unable to pull
____ sheets from his mouth
AG2 brought to medical; returned to
block with two backboards
AG3 was walking the block
AG3 arrived at cell A-8 around
00:40-00:45
AG3 saw the outline of detainee
under a blue blanket
AG3 banged on the bean hole but
received no answer
AG3 noticed white sheet hanging up
and whispered “Fuck.” (CITF only)
AG3 ran and got ____ who banged
on A-8
Some of the detainees began to say
“Shhh! Quiet!” (CITF only)
____ opened the bean hole and
pulled the blanket off the bunk and
yelled YELLOW
____ looked into A-8 through an
outside window and yelled, “He’s
hanging, he’s hanging!”
____ opened the door
AG3 took detainee down and zip-tied
his wrists and ankles
AG3 brought A-8 to clinic
AG4 saw detainee shackled on the
tier
AG4 assisted in taking detainee to
medical clinic
AG4 returned to A-block
____ requested AG4 to help at A-12
SOG saw block NCO and guards
remove detainee from cell
SOG heard about A-12 and did not
go to A-12, but sent others
Someone got NCO to help wake A-8
NCO pushed mattress propped on the
front of the cell wall
NCO tapped on the cell
NCO opened bean hole
NCO pulled on detainee’s blanket
two to three times and discovered he
was not in his bed
NCO said “He’s not here.”
____ walked to rear of A-8, looked in
the back window and yelled, “He’s
hanging, he’s hanging!”
NCO ran detainee to medical clinic

Platoon Leader heard “ ____ Alpha
Block” over his radio and ran to

•
•
•
•

•
•

•
•

•
•
•
•
•
•
•
•
•

•

•
•
•

Urine spots
Eyes wide open
Hands bound in
front of body
Binding on head,
across forehead,
under chin and over
mouth
Material jammed in
mouth
Purple fingers

Something white
around detainee’s
neck
Rigor mortis
Blue feet
Eyes half open
Detainee totally limp
Eyes open
Cold to touch
Blue fingers and
blue toes
Hands, wrists, feet,
and ankles bound
with cloth
Looked like surgical
mask on face and
underneath____
which I could not
pull out
Material wrapped
around head and
neck
Eyes rolled back
Someone appeared

A- 17



(NCIS 936, 940)
•

•
•

•
•
Finding of
Detainee 588 in
Cell A-12

Alpha Guard #1
(NCIS 957, CITF 953)
Alpha Guard #2
(NCIS 964, CITF 961)

•
•
•
•
•

Alpha Guard #4
(NCIS 982, CITF 978)

•
•
•

Alpha Block Sergeant
of the Guard – SOG
(NCIS 942)
Alpha Block Platoon
Leader
(NCIS 936, 940)

•
•
•
•
•
•
•
•
•

Finding of
Detainee 693 in
Cell A-5

Alpha Guard #1
(NCIS 957, CITF 953)

•
•
•
•
•
•

Alpha Guard #2
(NCIS 964, CITF 961)

•
•
•

Alpha Block
Platoon Leader saw guards outside
A-8 with two guards holding 0093’s
hands and feet
Observed 0093 lying on deck in his
cell
Platoon Leader went to guard shack
and called DOC stating, “ ____
0093” then asked for a medical
response and hung up
Platoon Leader ran back to A-8
Four guards picked up the backboard
with 0093 on it and ran to medical
Platoon Leader headed to medical
AG1 heard others yelling at A-12
AG1 saw people entering cell A-12
AG2 opened door to A-12, because
____ said he was not in his cell
AG2 thinks she cut down the
detainee
AG4 could not get detainee’s
attention
AG4 went to the rear of the cell and
saw a pair of hands
AG4 ran to the front and screamed
“____”
AG4 entered the cell
AG4 ran detainee to medical
SOG could not see detainee well
Someone told SOG pulled ____
Platoon Leader ran from medical to
A-12 when he heard the second radio
call
Platoon Leader saw two guards at A12
Observed 0588 lying on deck
Directed someone to bring a
backboard
Directed others to take 0588 to
medical
AG1 walked the tier and saw no one
in A-5
AG1 began screaming
AG1 entered cell A-5 with two other
MAs
AG1 yanked on the blanket hanging
from the ceiling until it finally fell
AG1 lifted the detainee’s torso to the
ground
The others took the detainee from
AG1
AG2 opened the cell door for escorts
AG2 ran to get shears
Detainee was on his way to medical

•

to be ____ and I told
them to take it out
but they were unable
Someone said “no
pulse”

•
•

Mask made of sheet
in his mouth and
wrapped around his
head
Urination and
defecation
Rigor mortis
Hands and feet cold

•

Blue feet

•
•

Hands bound
Twisted rope made
from sheets around
his neck

•
•

Cold to touch
Smelled of feces

•

•

A- 18




Alpha Block Platoon
Leader
(NCIS 936, 940)

•
•
•
•

when AG2 returned to cell A-5 with
shears
Platoon Leader heard someone shout
“A-5”
Platoon Leader went to A-5
0693 had been cut down and was
lying on the deck
0693 was taken to medical

Statements Concerning Post-Suicide Conference
ACTOR/PAGE #

ACTIONS/OBSERVATIONS

Alpha Guard #4
(NCIS 982, CITF 978)

•
•

•

Was advised to report to JDG office to prepare incident report
Prior to finishing his report, he was instructed to wait in JDG conference room
where someone would come interview him
_____ escorted him to JDG conference room
Among those waiting in the conference room, there was no discussion of the night’s
events beyond “it’s a crazy night”
Many guards remained quiet
Others talked about cartoons
He waited in conference room until instructed to leave for his interview
Interview began at 0442 hrs
Escorted to JDG conference room
No discussion of night’s events among those in conference waiting room
Interview began at 04:12
At 01:00 told block guards not to enter cells
Cell doors closed, but not locked
A-block team was called to fill out 2823’s (sworn statements)
Sent A-block over and they were informed to speak with _____
01:30-02:00 someone told me to go to DOC to do a sworn statement
“I went and was told not to do a sworn statement because I would prepare one for
NCIS”
“I went back to bring others to the DOC to meet with _____ and an NCIS agent”

Guard (non-Alpha)
(CITF 1029, NCIS
1031)

•
•

IRF Guard
(CITF 1036, NCIS
1038)
Alpha Block Sergeant
of the Guard – SOG
(NCIS 942)

•
•
•
•
•
•
•
•
•
•
•
•
•

Guard (non-Alpha)
(NCIS 987, NCIS 989)

•
•
•

Was taping off cell blocks when told to report to BLDG 1
Saw ____ on orders from ____
Spoke to NCIS agent

Echo Guard
(NCIS 1011, CITF
1009)

•
•
•

Escort Control
(NCIS 1002, 1003)

•
•
•

Escort Control
(NCIS 1015)

•
•

“_____ told _____ and me to go with him to conference room”
_____ met everyone who was involved in the incident in the conference room
_____ instructed the guards to sign a roster and to annotate their names with an
asterisk if they were assigned to A-block that night
Went with ISN 693 to clinic until told to respond to BLDG 1
Assisted separating ISN 693 and ISN 588 at the clinic
A few moments later, ____ requested his presence in the conference room at BLDG
1
Returned from hospital at about 02:00-02:30
Was directed to one of two locations
o DOC
o Location to be interviewed by NCIS
Interviewed by NCIS at DOC
Was asked to stay at DOC after interview
“I left to bring a sick friend home”
Stayed outside A-block until relieved by incoming shift

Officer
(NCIS 1034)

•
•
•
•

A- 19



Guard (non-Alpha)
(NCIS 1042)

•

Commander
(NCIS 1054)

•
•
•
•
•
•
•
•
•
•
•
•

•

Corpsman
(NCIS 1086)

•
•
•
•
•

Escort Control
(NCIS 1099)

•

Left camp at 01:30 in a van to bring guards into the fence, because a recall was
ordered
Upon returning, stayed at camp until was told would be interviewed by investigators
Asked for 100% recall
Told someone to get any guards involved to the conference room as soon as they
could be relieved by substitute guards
At 01:10 the deputy commander arrived at the DET Clinic and Commander sent her
to the DOC and told her to start organizing guards coming in so that they would have
three people to walk every tier
About 01:25-01:30 Commander went to the DOC, which is located in his
headquarters (BLDG 1)
“At the DOC I tried to get the people directly involved with the incident together in
the conference room”
“I told them to sit and not to talk to each other”
“I pulled 3 or 4 Alpha guards into my office to find out what had happened and put
together the series of events”
Commander had each of them speak to him for approximately 4-5 minutes in his
office
Included in the first set of people I spoke with were the SOG and Sailor who found
ISN 0093 in the cell
I was told the guard who found 0093 had just come onto the tier
According to what he had been told, the NCO and ___ were in the guard shack, two
other guards were passing each other in the Sally on way to chow – this leaving one
guard who discovered the detainee
At 02:00 ___ showed up and Commander left the guards to sit in the conference
room and went with ____ into his office and briefed him
Then ____ from CITF and ____ from FBI arrived
Went to the conference room and told all present to talk to NCIS
Talked to NCIS agent
Gave her information
Filled out a handwritten statement and gave it to a corpsman who gave it to a Navy
Lieutenant
Stayed with the bodies with____ until relieved from duty

Appendix F

Information from Escort Statements in NCIS report (By page numbers)

A- 20



ACTOR/PAGE
#
Escort Control
(NCIS 996)

EVENT
Finding 693

ACTIONS
•

•
•
•
•
•
•

•
•
•

•
•

Escort Control
(NCIS 998)

At the DET
Clinic with
ISN 093

•
•
•

Naval Hospital
with ISN 093

•
•
•

Escort Control
(NCIS 1000,
1023, and 1028)

Response to
693

•
•
•
•

Escorts saw that the second detainee in Cell
A12 was already down, and that guards were
placing him on a backboard
Escort saw a “small Asian female guard”
banging on the cells, trying to wake up all of
the detainees
Escort heard the guard say, “A5 is not
responding”
A guard helping with A12 ran over and
unlocked the cell
Other people entered the cell
Escort stayed outside the cell because there
were already four people inside
Others held the body up while two guards
from A-Block cut it down (Escort does not
remember seeing shears to cut the detainee
down)
Escort ran towards the clinic to get a
backboard
Escort ran into someone inside the Sally 3
gates who had a backboard, so both ran to A5
Escort put the board down outside the cell and
loosened the straps, then laid it on the deck
inside the cell next to the detainee
Two guards rolled the detainee onto the
backboard and strapped him down
Escort and two guards from A-Block carried
the detainee on the backboard to the deck
clinic
Escort responded to Alpha block after the first
call
Escort was assigned to assist at the DET clinic
with 093 with CPR
Escort observed a Combat Camera filming the
bodies of the three detainees
Escort assisted medical personnel with CPR in
the ambulance
Ambulance arrived at the Naval hospital at
approximately 01:11
ISN 093 was brought into the Detainee Wing
where the hospital medical personnel worked
on him until he was declared dead at
approximately 01:50

OBSERVATIONS
•
•

Eyes open
Thought detainee
was alive but
unconscious
Reaction of detainees

•

•

•
•
•

Escort noticed that
all the detainees on
A-block were very
quiet when they
responded to the call
(“Usually, when
there is a [code] the
other detainees on
the block make a lot
of noise and call out,
‘Help my brother!’”)
Escort thinks that
they already knew
what happened

Blood coming out of
093’s mouth
Swelling in the neck
Material layered
around 093’s neck
The Escort stated the
rescue personnel cut
off the material on
the way to the
hospital

Escort ran following other military members
to Alpha Block cell A-12
Escort did not see anything because of other
people in the way
Escort went to Cell A-5, where she observed a
detainee hanging
Escort stood on the left side of the cell and

A- 21



•

•
At the DET
Clinic with
ISN 693

•
•
•

At the DET
Clinic with
ISN 588

•

•
•
•
•
•
•
•
•

•

Escort Control
(NCIS 1002,
1003)

At the Escort
Control

•
•
•

Response to
ISN 588

•
•

held back a blanket tied to the wall
Escort saw an arm with shears in hand come
over her right shoulder to cut the cord around
the detainee’s neck. She did not see who the
person was, but she grabbed the hand and
shears and moved them to a better location
Escort started pulling at the cloth around the
detainee’s neck to unravel it
Escort helped put 693 on the backboard and
carry him to the DET Clinic
Escort helped to stabilize a corpsman who was
performing CPR on 588
Escort observed a deep indentation on the
neck of 693
Escort and others held on to both of his feet
and legs while a corpsman was administering
CPR
Corpsmen did shifts for CPR with a second
corpsman
Escort went to the other side of the table and
assisted holding an oxygen mask in place
Escort did not recall if she was able to bend
the elbow of the detainee
A corpsman arrived with special instruments
to try and pry the detainee’s mouth open
A surgeon came to help but also failed to pry
the detainee’s jaw open
Escort heard the physician comment that the
body appeared to be in the “preliminary stages
of rigor mortis”
Medics used a defibrillator to attempt to
revive 588, but it did not yield a response
Escort was told to take charge of the bodies
and not to permit anyone else to enter the
room
Admiral Harris arrived sometime afterwards
and provided a “quick de-brief” to everyone
and thanked them “for [their] cooperation in
handling this situation”
Escort reported for Mid-Watch at 05:00 on
June 9, 2006
Escort guard noted that around sunset the
inmates from the Alpha Block were singing
louder than normal and more in unison
Entire escort team was in the office 5-10
minutes before midnight when Escort Control
received a phone call with code “Yellow”
indicating a detainee medical emergency
Escort arrived at the Alpha Block and 093 had
already been removed from the block
Escort entered Alpha Block to see the second
detainee, from A-12 (ISN 588) on the ground
while a number of Sergeants of the Guard
(SOG) and Alpha Block personnel were
placing 588 onto a blackboard

•
•
•

•
•
•
•

•
•
•
•
•

Cloth around at least
one wrist
Fixed and dilated
pupils
Fingernails and feet
were purple/blue
Locked jaw and
teeth clenched shut
“Goldish brown
material” in 588’s
mouth
Chest displayed
normal color
Blue fingers and
toes

No pulse or
respirations
No signs of life
Eyes open and black
Mouth open, could
see teeth
Toenails and

A- 22




Discovery of
ISN 693

•
•
•

•
•
•
•
•
•

•
•
•
•
At the DET
Clinic

•
•

•
•

•
•
•
•

•
•
Escort Control
(NCIS 1015)

Chanting

•

Escort heard someone shout “Alpha-5”, in
attempt to wake ISN 693
Escort thought that 693 was laying on his
bunk under a blanket before noticing a blanket
draped in the corner of the cell
An unidentified USN service member
unlocked the cell door and partially entered
the room and felt the bed as the escort looked
behind the blanket suspended in the corner of
the cell
Escort saw 693 hanging from the neck
between two blankets
Escort pulled on the blanket facing the front
of the cell and another person cut it free
Escort approached the body and lifted it to
release the tension on the noose
693’s waist was against the escort’s chest and
the detainee was suspended approximately six
inches from the deck
Someone cut the rope and escort transitioned
the detainee to the ground
Escort untied and shackled the detainee’s
hands and someone else untied the noose from
his neck
Escort called out for a backboard
Escort checked for respirations and a pulse,
but could not detect any signs of life
Escort instructed others to assist him in
placing 693 onto the backboard
Escort assisted in transporting him, running,
to the DET Clinic
Escort and others took 693 to room eleven
Escort noticed what he believed to be 093 in
the trauma area with emergency personnel
performing CPR
Escort volunteered to videotape the event
Escort ran the combat camera for
approximately two minutes until instructed by
someone to halt the taping
At approximately 01:16, the attending medical
doctor pronounced both 693 and 588 dead
Escort was assigned to guard the bodies.
Escort was told to relocate the body to room
10
Escort instructed someone to shut room ten’s
door and remain outside the door with
instructions to allow no one inside
Escort was informed that someone requested
his presence in the conference room.
Escort signed out of the logbook and departed
the medical facility to the conference room at
building one.
Escort heard chanting by the detainees, louder
than usual, and an interpreter was called for

•

•
•
•
•
•

•
•
•

fingernails started to
turn blue
Hands bound in
front of body with a
makeshift belt
Makeshift rope
wrapped several
times around neck
No signs of life
No pulse or
respirations
Cool to the touch
Ligature marks
around neck felt
rough and “plastic”
Mouth slightly open,
teeth visible
Saw nothing in
mouth
Eyes open, one
wider than the other

A- 23



The DET
Clinic

•

•
•
•

•
•

•
•
•

At the Naval
Hospital

•

•
•
•
•
•
Back at the
Camp later
that night and
the next
morning

•
•
•
•

•
•
•
•
Escort Control

Singing earlier

•

assistance
Escort informed of a code “Yellow,” which is
used for a medical emergency around
midnight
Escort and his partner started running toward
Sally Four, but were then told to go to the
DET Clinic
Escort was told that 093 was found hanging in
his cell
Escort and partner were told that there were
two more detainees being transported to the
clinic who were possible suicide victims
Escort’s responsibility was to monitor the
situation with 093
Escort observed the medics trying to get a
pulse from 093 and performing chest
compressions
Escort rode in the front of the ambulance
taking 093 to Naval hospital
Escort’s partner rode in the back and helped
two paramedics with chest compressions
The driver of the ambulance was one of their
own DET Clinic medics from the camp; the
two medics in the back were from the Naval
Hospital
Doctors worked on 093 trying to revive him,
from roughly 01:15 to 01:50 by adding
medicine to the IV and applying more chest
compressions; however their efforts were
fruitless
Escort explained to a commander on the
phone that they were still trying to revive 093
Commander called two more times and others
answered the phone
A doctor at the hospital pronounced 93 dead
at 01:50
Medics put a blanket over his body
A sergeant told the Escort and his partner to
return to the camp
Camp was chaotic, alive with activity
All of the escorts and block guards were
recalled
All of those involved were directed to one of
two locations to be interviewed by the NCIS
Half of them went to the Detention Operations
Center and half to another location to be
interviewed by the NCIS
An NCIS Special Agent interviewed the
escort at DOC
Escort asked to stay at the DOC for a while
after being interviewed
Escort took a friend home because she was
sick and left just before 05:00
Escort’s friend, another guard who worked at
Sally Four, was crying and vomiting
Escort was working with a partner at about

•
•
•
•
•
•
•

No signs of life
No movement
Eyes open, but still
No undershirt
Chest displayed
normal color
Blue hands and feet
Purple toenails

A- 24



(NCIS 1019)

that evening
•
•
•
•
•
•
•
Call and
leaving for 588

•
•
•
•
•
•
•
•
•
•
•
•

At the Clinic

•
•
•
•
•
•

•
•

•
•

18:30, going from Gold Building to Foxtrot
Block
Escort heard loud singing from entire block
Escort notes that the singing was unusual
because normally only a few detainees would
sing at one time
Escort arrived at Foxtrot Block and dropped
off the detainee
Escort asked a guard who was standing near a
translator what was going on
Translator did not specify what they were
singing about
Escort returned to the duty station
Escort left the duty station for “fresh air” at
22:30 PM while the singing continued
Around 00:45 a call came into Escort Control
Approximately 2 minutes later, a team was
dispatched to the location
Someone came to the escort control and asked
for more help
Escort and his partner responded to the Alpha
Block to assist
Escort went to get restraints
Some guards were standing in around a cell of
detainee number 588
Detainee was already down on the deck with
his head towards the rear of the cell
Another person said, “There is another one
here,” or something similar, referring to A-5
Approximately three guards left the cell and
responded to A-5
Escort went to get a stretcher by the front
shack of Alpha Block
Escort returned to 588’s cell and put the
stretcher halfway into the cell door
Escort assisted in moving the detainee to the
stretcher by his ankles
Escort helped carry 588 to the “hospital” and
placed the detainee on a bed
Escort stayed while the other guards returned
back to Alpha Block
3 corpsmen entered and performed CPR on
the detainee
A corpsman put an IV in his arm
Escort assisted by keeping the CPR
performing corpsman from falling off the bed
Escort also saw a black female lieutenant
bring in the electrodes and shock the detainee
three times with no response
Doctor in civilian clothes entered the room
Doctor tried to open the detainee’s mouth to
give him medical attention but it was too stiff
to open
Doctor pronounced the detainee dead at 01:15
All the corpsmen left the room; the escort
remained with the body

•
•
•

Ankles cold
Toe and fingernails
were purple
White palms

A- 25



•
At the Naval
Hospital
Later that
night / and the
next morning

•
•
•
•

•
•
Statements
regarding
procedures

•
•

•
•

Escort Control
(NCIS 1044)

•
•
•
At the DET
Clinic

•

•
•
•

•
•

•
•

•

Escort was relieved at about 01:30 and told to
watch 093 at the hospital
Escort and the person he was with were told
they were not needed
Escort was told to relieve one of the three
escort guards watching the two bodies
Escort relieved him and documented who
entered the room
NCIS investigators, along with combat
camera personnel, later entered the room and
the escort turned over his documentation
Bodies were put into bags and moved to the
morgue by ambulance
Escort and others were no longer needed so
they went back to escort control
Based on the escort’s training, nothing should
be hung above the beanhole
In some blocks there is a blackline painted on
the fence of cells indicating that nothing can
be hung above the line
Based on the escort’s experience, each camp
is operated differently
Escort has seen blankets and other items
hanging before but he never saw items hung
as high as the night the suicides took place
Guard from Camp One ran into the escort area
and requested all personnel on Alpha Block
693 had already been placed and strapped on a
medical backboard
Escort helped move 693 to the Detainee Clinic

•
•
•
•

Blue face
Stiff arm
No pulse
Something was
stuck in detainees
mouth

Escort helped take the detainee to the last
room and placed his body on the bed and
shackled one arm to the backboard per the
standard procedures
Someone initiated CPR and another person
provided artificial respiration
CPR was performed on 693 for about 45
minutes
A doctor on staff who was wearing civilian
clothes entered the room and tried to intubate
693
The doctor could not open the detainees
mouth with his hand, so he used a special tool
The doctor intubated 693 and another medical
corpsman resumed CPR for another 20
minutes
More officers and medical staff arrived at the
Clinic
A Navy Lieutenant came in and inspected the
detainee for vitals, then called the time of
death
Escort and another placed both bodies in one
room and were instructed to stand guard over
them

A- 26



•
•
Escort Control
(NCIS 1099)

Response to
693

•
•
•
•

•
•

At the DET
Clinic

•
•
•
•
•
•
•
•

•
•
•
•

•
•

Medical staff began prepping bodies for
transport to the morgue
A medic discovered a suicide note in a
detainee’s shirt pocket
Escorts were told there was a possible
snowball in Alpha Block
One team left escort control to assist Alpha
Block
A second team consisting of two other escorts
left the escort center to assist in Alpha Block
Someone from Camp One came into the
escort center and stated, “We need everyone
in the camps to help in Alpha Block”
Escort grabbed some shackles and left
Escort saw others gathered around the cell
where 693 was laying on the deck
Guards strapped the detainee onto the board
Escort helped take detainee to the clinic
693 was put onto a bed in the room
Corpsmen entered the room and began giving
medical attention to the detainee
Corpsmen performed CPR on the detainee for
a while and began getting tired
Female officer asked if anyone in the room
was qualified to perform CPR
Escort took over the oxygen bag and
continued giving 693 oxygen until another
corpsman brought in a big oxygen bag to
assist
588 was brought into the clinic on a
backboard
693 was pronounced dead at 01:16
Escort knew the medical clinic was now a
“crime scene”
All of the heavy medical equipment was
removed in case it was needed for other
victims
All hoses and other smaller medical
equipment stayed with the bodies
Escort and one other person stayed with the
two bodies (588 and 693) until relieved

A- 27




Appendix G

Details of the Detainee Statements during the NCIS and CITF Investigation
STATEMENT
PAGE #

STATEMENT

SUMMARY OF
NCIS
STATEMENTS
Detainee
(NCIS 1130)

•
•
•
•
•
•
•

# that saw any detainee actually hanging in the cell: 1/5
# that didn’t see or hear anything: 1/5
# that didn’t see anything: 3/5
Meds were brought around 19:00-20:00
Everything was normal in cell block
Went to sleep at 21:00
Woke at 04:00 when guards woke up

Detainee
(NCIS 1131)

•
•
•
•

Awoke at 00:30 by sound of guards running
Did not see anything, because cell was not near the detainees who committed suicide
Learned about the suicides from other detainees
There was one detainee who caused disturbances and was a troublemaker on the block

Detainee
(NCIS 1134)

•
•
•

No prior knowledge of suicides
Knew 93 and is surprised that he would hurt himself
Cell is located too far away to see anything

ISN 688
(NCIS 1140)

•
•
•
•
•
•
•
•
•
•
•
•
•
•

After prayer everyone went to sleep and he was the last to go to sleep
After midnight woke up to guards yelling out to a detainee
Heard a guard shout “he’s hanging”
Other detainees woke up because of all the shouting
Heard guards yelling to A-12, in whose cell a blanket was hanging
Heard the guards say “he hanged himself”
Saw detainee hanging from white rope made of sheet
Saw the guards take him down and take him away
On June 8 had Rec with A-8 who was happy
Believes the suicides occurred because of the pressure from guards
Awoke at 00:20 by guards shouting
The Guards removed the detainees from the cell block
Later learned that the detainees had hanged themselves
Spoke to one of the deceased detainees at 18:00 on June 9 and he promised to attend
Rec with him on June 10
Denied any prior knowledge of suicides
Asked guards about the death because more death was coming soon
40 brothers committed to die
“Will see the strong commitment when doing the autopsies”
Stopped us from dying by force feeding, so we are trying new things

Detainee
(NCIS 153)

Detainee
(NCIS 1201)

•
•
•
•
•

SUMMARY
Of CITF
STATEMENTS

•
•
•

Detainne
(CITF 1120)

•
•
•
•

# Interviewed: 15 Detainees
# that saw all three detainees dead: 4/15 (probably)
# that saw at least 1 detainee hanging in their cell: 2/15 (one saw ISN 093; one saw ISN
693)
# that didn’t see or hear anything: 1/15
# that didn’t see any of the detainees: 4/15
Went to sleep after evening prayer
Awoke to guards yelling at a detainee to wake up

A- 28



•
•
•
•
•
•
Detainee
(CITF 1122)
Detainee in cell
next to ISN 693
(CITF 1125)

Detainee in cell
next to ISN 093
(CITF 1126)

Detainee
(CITF 1128)

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Detainee
(CITF 1169)

Detainee
(CITF 1142)
Detainee
(CITF 1143)

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Five minutes later, yelling at another detainee (cell A 12) to wake up
Five minutes later, yelling at another detainee to wake up
Saw the guards take the three detainees away (“Saw them take three of my brothers”)
Did not have a good view, because of the guards crowding around
Was told to be quiet and then was moved to a different block
Things at the camp got worse when the Colonel took over—blames him and his
pressures for the suicides
Awoke to screaming guards
“Seeing the dead bodies didn’t bother me”
Does not associate with other detainees on the block
ISN 693 told him that he was going to say his evening and sunset prayers together but
not to wake him for evening prayers
Went to sleep after evening prayers
Awoke around 23:45-00:00 to telling and running guards
Saw a blanket up in A5
The guards went to A5 and when the guards took the blanket down, saw ISN 693
hanging
Watched guards remove him
Did not see or hear anything suspicious from A5 the night before
Spoke with 093 prior to the 21:30 prayer and everything seemed normal (“He ate and
prayed with everyone”)
During the 21:30 prayer session, another detainee started yelling curse words in Arabic
and the disruption upset 093 and many other detainees
After prayer 093 said he was going to wash his blanket
093 washed the blanket and hung it blocking the sink section of the cell
Went to sleep
Awoke to guards in 093’s cell
Saw 093 laying on the floor and he appeared unconscious
Could not see very well
No mention of the other two dead detainees
Saw 093 alive during the 21:30 prayer session
During the session, another detainee started yelling curse words in Arabic which upset
detainees
Awoke to shouting guards
Saw the guards
Saw 093 lying on his bed in supine position with sheet around his neck tied in some sort
of knot
Could not see very well but saw them load 093 onto the stretcher and take him out
Did not observe the other two dead detainees
Went to sleep at 21:20
Between 00:30 and 00:35, awoke to guards yelling at A-8 to wake up
Guards pulled from the cell and saw something (redacted)
Guards said not breathing
Fifteen minutes later, yelling at A-12.
Guards took the detainee out from A-12 and said “not breathing”
Fifteen minutes later, yelling at A-5 and again a detainee was taken out of cell
Then they moved all three detainees
Could not see very well
Knew that the three were dead
Did not talk about incident, but blamed the Americans
Was asleep and then woke up to knowing and saw them take one of the detainees out of
their cell (did not specify which detainee or which cell)
Went to sleep at 21:30 and at that time 588 did not have sheets hanging in his cell.
Talked to 588 occasionally
Awoke to yelling but did not focus on anything

A- 29



Detainee
(CITF 1144)

•
•
•
•
•

Overheard the guards say, “He’s Done”
Saw the detainees speaking during Rec within the last few days
End of three detainees hunger strike caused detainees to be even more vigilant in
patrolling (“guards appeared to be watching them more closely, conducting even more
roaming patrols of the block, that is, constantly walked up and down the block
sometimes interrupting sleep by the frequency they walked by the cells”)
During the chanting sessions some detainees add their own commentary to entertain
themselves (in response to question whether there were comments about one of the
three dead detainees, criticizing the US, or ridiculing the guard force)
Went to sleep after chanting and was awakened by guard personnel after discovering
that one of the detainees hanged himself
Very concerned with being misrepresented
Friday was normal
Can not remember if 093 participated in Friday chanting or ate dinner
Went to sleep after prayer around 22:00
Awoke to the guards calling 093 several times
Saw blanket hanging in cell
When guards took blanket down, saw 093 hanging with hands and feet tied
Guards removed 093 from the cell
Ten minutes later, attempted to go back to sleep but heard guards yelling at another cell,
which was out of his sight
Before second detainee was removed, heard guards at a third cell
One guard said they died, another said no they did not
Went to sleep after prayer around 22:00 and awoke to strange noises
Saw guards go by with three stretchers and then remove the bodies
Did not know or see anything

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Normal day, went to sleep after prayer
Awoke to guards calling out number 8
Guards saw someone hanging and took him to the hospital
Went back to sleep and after some time “we heard” them call number 12
Do not know why or how the detainees hanged themselves
Cell is on the opposite end of the tier than the three deceased detainees
Sleeping soundly until awakened by yelling and shouting
Awoke and saw several guards running on the tier
Went to sleep between 20:00 and 20:30
Awoke around 00:30 to guards yelling, “Number 12”
Blanket was hanging in the cell
Opened the cell door and brought out 588
Heard Guards talking about 093 in A5
Heard them enter another cell
Guards came back and ordered that everything hanging in cells be taken down
Was awake until 03:00 when he was transferred

•
•
•

•
•
Detainee
(CITF 1146)

Detainee
(CITF 1148)
Detainee
(CITF 1150)
Detainee
(CITF 1151)

Detainee
(CITF 1137)
Detainee
(CITF 1138)

•
•
•
•
•
•
•
•
•

A- 30




Appendix H
False Statement and Failure to Obey Direct Orders
The interviews for each individual guard are grouped together in the NCIS file, appearing
for the most part in consecutive pages. Included among the interviews are forms titled, “Military
Suspect’s Acknowledgement and Waiver of Rights,” which appear before each of the four Alpha
Guards’ interviews and the Alpha NCO’s and Platoon Leader’s interviews. These forms follow
the June 10 CITF interviews, except in the case of the Alpha NCO, where the form appears
before his June 10 NCIS interview, and before the June NCIS first-person written narratives.
Copies of the forms are reproduced in the following pages.

Table 3: False Statement and Failure to Obey Direct Orders Waivers
GUARD
AG1

“Military Suspect’s Acknowledgement and
Waiver of Rights” Accusation
“I am an [sic] suspected of False official Statement
Article 107, and Failure to obey an order or regulation
Article 92.”

AG2

“I am suspected of failure to obey a direct order.”

AG3

“I am suspected of providing a false official statement.”

AG4
Alpha NCO

Camp 1 Platoon
Leader

“I am suspected of False official statements, UCMJ
Article 107.”
“I am suspected of False Official Statements, UCMJ
Article 107.”

“I am suspected of FALSE OFFICIAL STATEMENT.”

When Signed
Signed the same day as written
narrative. 15 Jun 2006
Signed a day before written
narrative.
14 Jun 06; 15 Jun 06
Signed the same day as written
narrative.
14 Jun 06
Signed the same day as written
narrative. Date Redacted
Signed the same day as written
narrative. 15 Jun 06
Signed one day after June 14
interview. Signed a second time
on June 16 during a reinterrogation, which is
subsequently dated June 17.

A- 31




AG1

A- 32




AG2

A- 33




AG3

A- 34




AG4

A- 35




Alpha NCO

A- 36




Camp 1 Platoon Leader

A- 37




Appendix I

Discount of the NCIS Statement on Detainee Suicides
The 2-page summary released by the Department of Defense in August 2008 leaves many
questions unanswered regarding the three deaths at Camp Delta. The investigative materials do
not corroborate the NCIS summary statement. In fact, this summary directly contradicts the
investigative materials released by the DOD. After twenty-six months of “investigating” the
incident, this summary leaves much unanswered. Set out below, statement by statement, are the
findings from the investigation materials that contradict the NCIS Summary Statement.
NCIS closes investigation into the 2006 deaths of three Guantanamo Bay detainees;
investigative reports released
NCIS Statement of Findings in italics:
“On June 10, 2006 the Naval Criminal Investigative Service (NCIS) was notified
that three detainees being held in Camp Delta at Guantanamo Bay Cuba had
been found unresponsive in their cells at approximately 12:30 a.m., apparently
having taken their own lives by hanging themselves with braided rope made from
bed sheets and tee shirts.”
“Five block guards were on duty at the time of the deaths. Blankets and sheets
had been used to obstruct the guards’ views and to create the appearance that the
detainees were asleep in their cells.”
As evidenced from medical reports and guard observations, the detainees were in a state of rigor
mortis at the time of their discovery, indicating they were dead for at least 2 hours prior to
discovery.2 Rigor mortis takes anywhere from 2-4 hours to set in, and it starts in the small
muscles first. Thus, for rigor mortis to begin the detainees must have died at or prior to 22:30.3
Blankets and sheets hung from the ceiling was unusual and against SOP regulations, so while the
blankets would obstruct the guards’ view, they would also alert the guards to unusual activity.4 If
the block guards had been following Standard Operating Procedure – locating movement or skin

























































2

NCIS at 942, 984, 943, 1019
See section 5d.
4
NCIS at 1058; 2004 SOP at 13.3-13.4.
3

A- 38



within each cell while walking the block – it is impossible for not just one, but three detainees to
have been hanging for such a substantial period of time.5
“Two of the detainees-- Ali Abdulla Ahmed, from Yemen, (DOB August 1, 1979)
and Mana Shaman Allabard al Tabi of Saudi Arabia (DOB Jan 1, 1976) were
determined to be dead at the scene.”
Unless the detainee clinic is considered part of the “scene,” the detainees were not determined to
be dead at the scene; there was no medical crew on the block to pronounce the detainees
medically deceased.6 They were pronounced dead at the clinic at least thirty minutes after their
removal from Alpha block.7
“Lifesaving attempts were begun on the third detainee--Yasser Talal al Zahrani
of Saudi Arabia (DOB Dec 26, 1983) who was transported to Naval Hospital
Guantanamo where he was pronounced dead a short time later.”
According to some reports, this detainee was not pronounced dead at the Naval Hospital until
01:50, over an hour after his discovery.8
“The detainees had last been seen alive at approximately 10:00 pm on June 9,
2006.”
The last time any guard stated having seen all three alive was at 20:30.9 Additionally, this does
not corroborate the condition of rigor mortis, which shows the detainees were likely dead before
this time. Although the detainees could have been alive at this time, it is unclear whether they
were seen alive in their cells or at another location. The DIMS record indicates all detainees
were “accounted for” at 23:47; however, it is unclear whether they were in their cells or
elsewhere.10
“NCIS Special Agents based at Guantanamo were notified when the deaths were
discovered and were on scene in the cellblock by 1:00 a.m.”
NCIS could not have been notified of the deaths and have arrived on the cellblock by 01:00 if the
detainees were pronounced dead at 01:15 or later.
“Five Special Agents from the NCIS Southeast Field Office Major Case Response
Team based in Mayport Florida were dispatched and arrived on scene at
approximately 3:30 pm on June 10.”

























































5

2004 SOP at 6.1.
NCIS at 942, 948, 957, 964, 973.
7
NCIS at 1073, 1083, 1089, 1090 (both indicate 588 and 693 were pronounced dead around 01:15 at the Detainee
Clinic).
8
NCIS at 1119.
9
NCIS at 958.
10
SJA at 12; see also CITF at 35.
6

A- 39



“Though there were three detainee deaths it was determined that the best course
of action was to combine the three incidents into a single investigation.”
“Autopsies were performed by physicians from the Armed Forces Institute of
Pathology at Naval Hospital Guantanamo on June 10 and 11. The manner of
death for all detainees was determined to be suicide and the cause of death was
determined to be by hanging, the medical term being “mechanical asphyxia.”
“A short written statement declaring their intent to be martyrs was found in the
pockets of each of the detainees.”
“Lengthier written statements were also found in each of their cells.”
“Due to similarities in the wording of the statements and the manner of suicides,
as well as statements made by other detainees interviewed, there was growing
concern that someone within the Camp Delta population was directing detainees
to commit suicide and that additional suicides might be imminent.”
“Representatives of other law enforcement agencies involved in the investigation
were later told that on the night in question, another detainee (who did not later
commit suicide) had walked through the cell block telling people ‘tonight’s the
night.’”
There is no evidence or report in the investigative documents indicating this incident of a
detainee walking through a cell-block. If the detainees are locked in their cells, it is not possible
for a detainee to walk through the cell block telling people “tonight’s the night.” Further,
detainees are not allowed to talk to one another, and if a guard heard a detainee make this
statement, that raises the question of why the guard would take no action based on the statement.
“The cells of other detainees were searched during the week following the
suicides in an attempt to find evidence regarding whether the suicides had been
part of a larger conspiracy which might result in additional detainees also taking
their lives.”
“During those searches a number of documents were seized as evidence and
taken from the cells for translation and analysis. Those documents included
additional handwritten notes found in cells other than those where the suicides
took place.”
“Those documents filled 34 boxes and 1 bag. Their combined weight was 1065
pounds.”
“Due to the volume of material seized, and concerns that numerous documents
stamped with ‘ACP’ might possibly be protected by attorney client privilege, the
NCIS Special Agent in Charge of the Southeast Field Office, directed that the

A- 40



documents be sealed and set aside until a process could be created to review the
documents in a way that did not violate any attorney-client privilege.”
“With the assistance of the Department of Justice and consistent with orders of
the federal District Court in Washington, D.C., the Department of Defense
appointed a ‘walled off’ team of individuals who were not involved in any other
detainee cases or proceedings to determine whether any of these seized
documents were relevant to the investigation and, if so, to provide them to
investigators unless they were protected by an attorney client privilege. Although
this team did provide documents to investigators, no attorney-client privileged
materials were included and this team did not reveal any attorney-client material
to anyone involved in the investigation.”
“That team was activated on October 23, 2006 at the Regional Legal Service
Office at Naval Air Station Mayport Florida.”
“The team consisted of an NCIS Supervisory Special Agent from Cherry Point
North Carolina, four Naval Officers from the Judge Advocate General’s Corps, 2
Naval Enlisted Administrative personnel, four foreign language translators, one
NCIS evidence custodian from the NCIS Southeast Field Office and one
additional NCIS Special Agent based at the Federal Law Enforcement Training
Center in Glynco, Georgia.”
“The NCIS investigation was conducted on behalf of the US Southern Command
(USSOUTHCOM).”
This summary focuses on the documents seized from all detainees’ cells and the process for
investigating these papers.
“It is not unusual for an NCIS death investigation to remain open for a year or
more due to a number of factors. Those factors include but are not limited to: the
number of parties involved in the case, any unique characteristics of the incident
location and environment, the amount of evidence collected and the level of effort
involved in analyzing that evidence, and the level of supervisory case review
given each investigation.”
“The Naval Criminal Investigative Service, as its name implies, is a fact-finding
entity. It does not draw prosecutorial conclusions nor make recommendations
regarding potential courses of action which could result from the investigative
findings.”
“The NCIS case file, redacted consistent with applicable Freedom of Information
Act exemptions, was provided to the Dickstein Shapiro law firm in response to
their FOIA request.”

A- 41



With no answers to the basic questions of who, what, where, when, why and how of this
investigation, this two-page summary leaves many questions unanswered as to how three
detainees were able to commit suicide by hanging, and remain undetected for at least two hours.

A- 42




Appendix J

Missing and Redacted Pages
Table 4: Missing Pages from the Combined NCIS File
Handwritten
Page
Numbers

Location
Of Pages

a-c

NCIS

1-16
17-24

NCIS
NCIS

25-64
65-71
72-158
159-189
190-219
220-240
241-431
432
433-461
462
463-468
469-472
473-477
478-727

NCIS
NCIS
NCIS
NCIS
AFME**
NCIS
SOUTHCOM
NCIS
CITF
NCIS
SOUTHCOM
NCIS
NCIS
SOUTHCOM

728-735
736-769
770
771-792
793-794
795-829
830-836
837-866
867
868-913
914-925
926
927-932
933
934
935-952

NCIS
AFME
NCIS
AFME
NCIS
AFME
NCIS
SOUTHCOM
NCIS
SOUTHCOM
NCIS
NCIS
SOUTHCOM
NCIS
SOUTHCOM
NCIS

Contents

Missing
Pages

Summary of investigation and list of exhibits
Repeats summary of investigation and information on seized
documents
(DPIS*) DOJ documents regarding FLT procedure
Repeats summary of investigation and information on seized
documents
Information on the FLT review of the seized documents
(DPIS) DOJ documents regarding FLT procedure
Forensic info, statements
(DPIS) AFME
Forensic info, chain of custody, evidentiary info
(DPIS) Photo log
Evidentiary info
(DPIS) Info on 693
Refers to 44 previous suicide attempts at GTMO
(DPIS) SOUTHCOM
Linguist interview
SOP information and previous guard messages
(DPIS) SOUTHCOM documents
Suicide note info, statement regarding morning after incident,
autopsy photo list
(DPIS) AFME documents
Autopsy photo list
(DPIS) AFME documents
List of autopsy photos
(DPIS) AFME documents
NCIS memos requesting evidence
(DPIS) Info given to NCIS, SOUTHCOM documents
Memo to SOUTHCOM
(DPIS) SOUTHCOM documents
List of interviews, statements, examinations
Info from Security Systems Officer
(DPIS) SOUTHCOM interviews
Receipt of watch bill
(DPIS) SOUTHCOM document
Personnel statements

0
0
0
0
0
0
0
30
0
186
0
26
0
6
0
0
250
0
34
0
22
0
35
0
25
0
0
0
0
0
0
1
0

A- 43



953-955
956-960
961-962
963-967
968-971
972-977
978-980
981-1008
1009-1010
1011-1028

CITF
NCIS
CITF
NCIS
CITF
NCIS
CITF
NCIS
CITF
NCIS

(DPIS) Personnel statement
Personnel statement
(DPIS) Personnel statement
Personnel statement
(DPIS) Personnel statement
Personnel statements
(DPIS) Personnel statement
Personnel statements
(DPIS) Personnel statement
Personnel statements

0
0
0
0
0
0
0
0
0
0

1029-1030
1031-1035
1036-1037
1038-1048
1049-1053
1054-1064
1065-1067
1068-1104
1105-1107
1108-1109
1110-1112
1113
1114-1118
1119
1120-1129
1130-1131
1132-1133
1134
1135-1136
1137-1139
1140-1141
1142-1152
1153
1154-1168
1169-1170
1171-1200
1201-1202
1203-1207
1208-1238
1239-1240
1241-1243
1244-1246
1247-1260
1261-1263
1264-1277
1278-1280
1281-1294

CITF
NCIS
CITF
NCIS
SOUTHCOM
NCIS
CITF
NCIS
BMS***
NCIS
BMS
NCIS
BMS
NCIS
CITF
NCIS
FBI
NCIS
FBI
CITF
NCIS
CITF
NCIS
FBI
CITF
FBI
NCIS
CITF
SOUTHCOM
NCIS
CITF
NCIS
SOUTHCOM
NCIS
SOUTHCOM
NCIS
SOUTHCOM

(DPIS) Personnel statement
Personnel statements
(DPIS) Personnel statement
Personnel statements, meal menu
(DPIS) SOUTHCOM documents
Personnel statement
(DPIS) Personnel statements
Personnel statements
(DPIS) BMS documents
Personnel statement
(DPIS) BMS documents
Personnel statement
(DPIS) BMS documents
Time of death info
(DPIS) Detainee statements
Detainee statements
(DPIS) FBI documents
Detainee statement
(DPIS) FBI documents
(DPIS) Detainee statements
Detainee statement
(DPIS) Detainee statements
Detainee statement
(DPIS) FBI documents
(DPIS) Detainee statement
(DPIS) FBI documents
Detainee statement, examination of 588
(DPIS) Examination of 588, DPIS referring to SOUTHCOM
(DPIS) SOUTHCOM documents
Suicide note translations
(DPIS) Copies of suicide notes
Cell walk-through info
(DPIS) Crime scene log
Cell walk-through info
(DPIS) Crime scene log
Cell walk-through info
(DPIS) SOUTHCOM documents

0
0
0
0
0
0
0
0
3
0
3
0
5
0
0
0
2
0
2
0
0
0
0
15
0
30
0
0
31
0
0
0
7
0
7
0
8

A- 44



1295-1313
1314-1353
1354
1355-1360
1361-1362
1363-1371
1372
1373-1381
1382-1385
1386-1391
1392
1393-1421
1422-1425
1426

NCIS
SOUTHCOM
NCIS
SOUTHCOM
NCIS
SOUTHCOM
NCIS
SOUTHCOM
NCIS
AFME
NCIS
SOUTHCOM
NCIS
SOUTHCOM

Evidence gathering and fingerprinting info
(DPIS) Letters and translations
Log book info
(DPIS) Alpha block records
Death scene re-examination info
(DPIS) Letters and translations
Translation info
(DPIS) Letters and translations
Weather and seized documents info
(DPIS) AFME documents
Re-creation of death scenes
(DPIS) SOUTHCOM documents
Investigation info
(DPIS) SOUTHCOM document

Total Missing Pages:

0
0
0
0
0
0
0
0
0
6
0
26
0
1

761

*DPIS = Deleted Page Information Sheet (a page appears in the NCIS file alerting the reader that
the documents must be obtained
**AFME = Armed Forces Medical Examiner
***BMS = Bureau of Medicine and Surgery

A- 45



Table 5: Redacted Pages from the Individual Files*
Document

Autopsy
Report Pt. 1
Autopsy
Report Pt. 2
Autopsy
Report Pt. 3
CITF File
SJA File
SOUTHCOM
File
NCIS File

0

Half-toMostly
Redacted
Pages
0

Pages w/
Some
Redacted
Information
11

Pages w/
No
redacted
Info
0

No

0

0

10

0

0

9

No

0

0

9

0

0

144
330
702

Yes
No
Yes

66
1
545

8
277
65

56
39
30

14
13
62

0
0
0

503

Yes

0

39

325

92

Undeterminable
b/c page #’s are
handwritten
and nonsequential

612

389

480

181

# of Pages

Handwritten
Page
Numbering

11

No

10

Wholly
Redacted
Pages

TOTALS
1709
N/A
Placeholder Sheets referring to Another File: 47

Missing
Pages**
0

*A redaction occurs where information is blacked out or covered by a white box on the page.
Wholly redacted pages are those pages where the information on the entire page is blacked out or
covered by a blank box.
**No missing pages existed according to the page numbering of the files. The page numbers
used were those that pertained to the individual file, not the handwritten page numbers that
number the pages of the combined investigative file.

A- 46




Appendix K
Staff Log and Sworn Statement Forms for GTMO Detention Center Staff
The Daily Staff Journal must be used by each shift to record all daily activity including
“chow arrival times, headcount times and results, prayer call times, detainee requests to see JTFGTMO, detainee movements and other significant operational activities.11


























































11

SOP 5-3(s) (2004)

A- 47



The SOP’s require that 2823 sworn statements must be made for all such incidents
immediately upon the happening of the event.12


























































12

SOP 32-1 (2004).

A- 48




Appendix L

The Men Who Died
In the months prior to his death on June 10, 2006, Mani Shaman Turki Al-Habardi AlUtaybi was cleared for transfer to his native Saudi Arabia.13 Because of delays by the
Government, his lawyers were unable to tell him of the decision, and it is therefore unlikely he
was ever informed of his pending release.14 According to Government press releases, Al-Utaybi
was detained for the previous four years because of his involvement with Jama’at al Tablighi and
other undisclosed groups.15 The Government characterized Jama’at al Tablighi as a “militant
missionary group,” though in fact, Jama’at al Tablighi is a mainstream, worldwide religious
community.16
Ali Abdullah Ahmed, a Yemeni national, was purportedly suspected by the U.S.
Government of being a “mid- to high-level Al Qaeda operative” with access to “facilitators and
senior membership,” particularly Al Qaeda coordinator Abu Zubaydeh.17 However, this claim was
stated in a press release after Ahmed’s death, and cannot be corroborated by any available
evidence.18 In 2005, his father obtained counsel for Ahmed and made a videotape asking his son to


























































13

Denbeaux, Mark et al. JUNE 10TH SUICIDES AT GUANTÁNAMO: GOVERNMENT WORDS AND DEEDS COMPARED
(2006) [hereinafter “June 10th Suicides”] at 6, available at http://law.shu.edu/news/guantanamo_reports.htm.
14
Id.
15
Id. at 8.
16
Id. “Jama’at al Tablighi was founded in India in 1923 as a distinctly non-political Islamic evangelical group, and
it seems to have retained its aversion to politics to this day. Tablighi members visit mosques and university
campuses in small groups, often inviting young men to accompany them on their itinerant travels. Members wear
distinctive clothing meant to imitate the dress of the Prophet Muhammad.
Jama’at al Tablighi has a global presence. It is the largest Islamic revival movement in Great Britain, and it
is planning to construct in London the largest mosque in Western Europe. It is Pakistan’s largest Islamic group.
The New York Times, when describing Tablighi members in Yemen, compares them to the Jehovah’s Witnesses.
Jama’at al Tablighi is also present in the United States. The Al Fala mosque in Corona, Queens, NY draws
hundreds of Tablighi members from across the nation.” Id. at 8-9 (internal citations omitted).
17
JUNE 10TH SUICIDES 11.
18
Id.

A- 49



cooperate with those lawyers.19 The Government reported difficulty in identifying Ahmed, blocking
any meeting with his attorneys prior to his death, so he never saw his father’s recorded plea.20
Nonetheless, there was a suit filed on Ahmed’s behalf in December of 2005.21

Yassar Talal Al-Zahrani was born on September 22, 1984, and was seventeen years old
when he was arrested by anti-Taliban forces in late 2001.22 In press statements after his death,
the Government accused Al-Zahrani of fighting on the front lines for the Taliban, facilitating
weapons purchases for the Taliban, and participating in the prison uprising that occurred at
Mazar-i-Sharif in Afghanistan on November 25, 2001.23 Al-Zahrani did not have representation
by counsel during his detention at Guantánamo.24


























































19

Id. at 10.
Id.
21
Id.
22
JUNE 10TH SUICIDES 11.
23
Id. at 11-12.
24
Id.
20

A- 50




Appendix M

Detainee Comfort Items 25


























































25

SOP at B.15 (2006).

A- 51




Appendix N

List Of Authorized/Unauthorized Activities As Per The 2004 SOPs26


























































26

SOP at B.16 (2006).

A- 52




Appendix O

Physical Descriptions of Signs of Death
QUALITATIVE DATA METHODOLOGY
Chart data was compiled using qualitative research methods.
First, each individual interview narrative (narrative) was catalogued and identified as either a
guard, medical, or other narrative.
Second, each narrative was analyzed word by word categorically. If a category was
identified in a description, then the narrative received a tally. For example, if a guard interview
narrative said that when the guard touched one of the detainees, the detainee was cold to the
touch, the narrative would receive a tally affirming that it described the detainee was cold to the
touch. The following table lists the methodology for each category.
Third, each tally was totaled.
CATEGORY
Blue
Bodily Fluids
Bound Feet
Bound Hands
Bound Neck

Bound Torso
Cold
Eyes

Gagged Mouth
Neck Abrasion

EXPLANATION
This category indicates that an interviewee described
one of the detainee’s skin as either blue or purple. This
is indicative of prolonged oxygen deprivation.
This category indicates that the interviewee described
that the detainee had defecated on himself.
This category indicates that the interviewee reported
that the detainee’s ankles and feet were bound upon
discovery with cloth material.
This category indicates that the interviewee reported
that the detainee’s hands and wrists were bound upon
discovery with cloth material.
This category indicates that the interviewee reported
that the detainee had cloth material wrapped around his
neck.
This category indicates that the interviewee reported
that the detainee had cloth material wrapped around his
torso.
This category indicates that the interviewee reported
that the detainee was felt physically cold in
temperature when touched by the interviewee.
This category indicates that the interview reported that
the detainees’ eyes were in a fixed gaze or that the eyes
were no longer exhibiting signs of life such as
movement, focusing, etc.
This category indicates that the interviewee reported
that there was a piece of cloth material was lodged in
the detainees’ mouth/airway.
This category indicates that the interviewee reported
that there was an abrasion on the detainee’s neck.

EXAMPLE
NCIS P. 959: “His fingertips were
blue.”
NCIS P. 975: “The detainee had
urinated on himself.
NCIS P. 950: “His hands/wrists and
feet/ankles were bound with cloth
material.”
NCIS P. 950: “His hands/wrists and
feet/ankles were bound with cloth
material.”
NCIS P. 1108: “…noticed what
appeared to be t-shirt material
wrapped around the neck at least 3-4
times about ¾ of an inch wide.”
NCIS P. 1060: I observed a towel or
something around the waist of one
detainee.”
NCIS P. 966: “I touched him and he
was cool.”
NCIS P. 1081: “His eyes were rolled
back.”
NCIS P. 1031: “His face was
towards me with his head slouching
down, a rag in his mouth.”
NCIS P. 1113: “…stated he
observed what appears to be a
bloody t-shirt around the neck of
V/AL ZAHRANI as well as a deep

A- 53




No AED Rhythm

No Pulse
Pale Skin
Rigor/Stiff

This category indicates that the interviewee reported
that when the AED machine was employed during
medical revival procedures, the machine could not
detect any sign life.
This category indicates that the interviewee reported
that the detainee did not have a pulse.
This category indicates that the interviewee reported
that the detainee’s skin was pale.
This category indicates that the interviewee reported
that the detainee was either in a state of rigor mortis or
that the detainee was stiff which is consistent with
rigor mortis.

abrasion narrow in width across the
victim’s neck.”
NCIS P. 1091: “The AED indicated
it detected “no shockable rhythm.”
NCIS P. 1075: “One of them
shouted he had no pulse.”
NCIS P. 1078: “The detainee was
pale and unresponsive.”
NCIS P. 1070: “I noticed that
ISN093 was cold and stiff because
his arm and fingers were stiff.”

A- 54



Chart 1: Total Physical Descriptions of Al Zahrani

Total Descriptions of Al Zahrani (ISN #093)
16
14

15

14
11

12
9

10

9

8
6

14

6

5

7

6
33

4

8

2

2

8
6

5
3

9
6

3

6
3

2

5

TOTAL DESCRIPTIONS

3
1

1

1

2

GUARDS

0

Total
Descriptions
Guards
Medics

MEDICS

Blue

Cold

Rigor/Stiff

Neck
Abrasions

Gagged
Mouth

No
Pulse

Eyes

Pale
Skin

Bodily
Fluids

3

No
AED
Rhythm
6

14

6

9

7

11

15

14

5
9

3
3

6
3

5
2

3
8

9
6

6
8

2
1

5
1

1
2

3

A- 55



Chart 2: Physical Descriptions of Al Zahrani By Guards Only

Physical Descriptions of Al Zahrani (ISN #093)
by Guards
10
9
8
7
6
5
4
3
2
1
0

9

8

8
6

3

3

2

Blue

AG1 (Alpha Block
Guard/956/NCIS)
AG1 (MA/953/CITF)
AG2 (alpha Block
Guard/964/NCIS/Alpha
Block Guard/962/CITF)
AG3 (ERF Team
Member/973/NCIS/Alpha
Block Guard/968/CITF)
AG4
(Guard/982/NCIS/Alpha
Block Guard/978/CITF)
Alpha NCO (Block
NCO/946, 948, 952/NCIS)
Commander (Joint Detention
Group
Commander/1054/NCIS)
Echo Guard
(guard/1011/NCIS)
Escort Control 2
(Escort/1015/NCIS)
Guard 1 (Alpha Block
Guard/1031/NCIS/Guard/102
9/CITF)
Guard 2 (Guard/987/NCIS)
Guard/981/NCIS

Cold

1

Rigor/
Stiff

Neck
Abrasion

Gagged
Mouth

No
Pulse

Eyes

2

1

Pale
Skin

No AED
Rhythm

Bodily
Fluids

1
1

0
0

0
0

0
0

1
1

0
0

0
0

0
0

0
0

0
0

1

1

0

0

1

0

1

0

0

1

1

0

0

0

1

1

1

0

0

1

0

0

1

0

0

0

0

0

0

0

0

0

0

0

1

1

0

0

0

0

0

0

0

1

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

1

1

0

0

0

0
0
0

1
0
0

1
0
0

0
0
0

1
0
1

0
0
0

0
0
1

1
0
0

0
0
0

0
0
0

A- 56



IRF Guard
(IRF/1038/NCIS/IRF/1036/C
ITF)
PL (Platoon
Leader/936/NCIS/940/NCIS)
REDACTED/1065/CITF
Sally Guard (Sally Gates
Guard/1006/NCIS)
SOG (SOG/942/NCIS)
TOTAL

1

0

0

0

0

1

0

0

0

0

0
1

0
1

0
1

0
1

0
1

1
1

1
1

0
0

0
1

0
0

1
1
1

0
0
0

0
0
0

0
0
0

0
0
1

0
0
0

0
1
0

0
0
0

0
0
0

0
0
0

A- 57



Chart 3: Physical Descriptions of Al Zahrani By Medics Only

Physical Descriptions of Al Zahrani (ISN #093) by
Medical Personnel
10
9
8
7
6
5
4
3
2
1
0

9
6

5
3

5

3

Blu
e
Corpsman/1075/NCI
S
Corpsman/1083/NCI
S
Corpsman/1090/NCI
S
EMT/1103/NCIS
EMT/1108/NCIS
ER
Doctor/1113/NCIS
Night Shift Team
Leader/1077/NCIS
Nurse/1070/NCIS
Nurse/1073/NCIS
Nurse/1093/NCIS
Nurse/186/NCIS
Redacted/1068/NCIS
Redacted/1081/NCIS
Redacted/1097/NCIS
TOTAL

6

5

Col
d

Rigor/Stif
f

2

Neck
Abrasion
s

Gagge
d
Mouth

No
Puls
e

Eye
s

1

Pale
Ski
n

No
AED
Rhyth
m

Bodil
y
Fluids

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0
0
1

0
0
0

0
0
0

0
0
0

0
0
0

0
1
1

0
0
1

0
0
0

0
1
1

0
0
0

0

0

0

1

0

0

1

0

0

0

0
1
1
1
0
1
0
0
5

0
1
1
0
0
1
0
0
3

1
1
1
1
1
0
1
0
6

1
1
0
1
0
0
0
1
5

0
0
0
1
0
1
0
1
3

1
1
1
0
0
1
1
1
9

1
1
0
0
0
1
1
0
6

1
0
0
0
0
1
0
0
2

1
1
0
0
0
0
0
1
5

0
0
0
0
0
0
1
0
1

A- 58



Chart 4: Total Physical Descriptions of Al Tabi

Total Descriptions of Al Tabi (ISN #588)
14

12

12
10
8

8
6

6
4
2

8

7
5

4
2

3

7
44

1

3

7 7
4

2

1

Total
Descriptions
Guards
Medics

Cold

8
2
6

4
1
3

1 1
0

0

0

Blue

44

3

Rigor/Stiff

Neck
Abrasions

Gagged
Mouth

12
7
5

8
4
4

3
2
1

TOTAL DESCRIPTIONS
0

No
Pulse

Eyes

7
4
3

MEDICS

1 1
0

GUARDS

Pale
Skin
7
0
7

1
0
1

No
AED
Rhythm

Bodily
Fluids

4
4
0

1
0
1

A- 59



Chart 5: Physical Descriptions of Al Tabi By Guards Only

Physical Descriptions of Al Tabi (ISN #588) by
Guards
8
7
6
5
4
3
2
1
0

7
6
5
4
3

?/1065/CITF
?/1203/CITF
AG1 (Alpha Block
Guard/956/NCIS/Alpha Block
Guard/964/NCIS/MA/954/CIT
F)
AG4
(Guard/982/NCIS/Guard/987/
NCIS)
Commander (Joint Detention
Group
Commander/1054/NCIS)
Echo Guard (?/1011/NCIS)
Echo Guard (Alpha Block
Guard/1009/CITF)
Escort Control 2
(Escort/1003/NCIS)
Escort Control 3
(Escort/1015/NCIS)
Escort Control 4
(Escort/1019/NCIS)
Escort Control 5
(Escort/1023/NCIS)
Guard 1 (Alpha Block

3
1

1

1
0

Blu
e

Col
d

Rigor/Sti
ff

0
0

0
0

1
0

0

0

0

Neck
Abrasio
ns

Gagge
d
Mouth

No
Puls
e

Eye
s
0
0

Pal
e
Ski
n
0
0

No
AED
Rhyth
m
0
0

Bodil
y
Fluid
s
0
0

1
1

0
0

0
0

0

0

0

0

0

0

0

0

1

1

0

0

0

1

0

0

1

0
0

0
0

0
0

1
0

0
0

0
0

1
0

0
0

0
0

0
0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

1

1

0

0

0

1

0

0

0

0

1

0

0

0

1

1

1

0

0

0

0

1

0

0

1
0

0
0

1
0

0
0

0
0

0
0

0
1

0
0

0
0

0
0

A- 60



Guard/1031/NCIS)
Guard 3
(MA/1041/NCIS/?/1042/NCIS
)
Master of Arms/1038/NCIS
SOG (SOG/942/NCIS)
TOTAL

0
1
1
6

0
1
0
3

0
1
0
5

0
1
0
4

1
0
0
1

1
1
0
3

1
1
0
7

0
0
0
1

0
0
0
0

0
0
0
1

A- 61



Chart 6: Physical Descriptions of Al Tabi By Medics Only

Physical Descriptions of Al Tabi (ISN #588) by
Medical Personnel
8
7
6
5
4
3
2
1
0

7

4

4

2

2
1
0

Blu
e
Corpsman/1083/NCI
S
Corpsman/1093/NCI
S
Night Shift Team
Leader/1077/NCIS
Nurse/1070/NCIS
Nurse/1074/NCIS
Nurse/184/NCIS
Redacted/1068/NCIS
Redacted/1081/NCIS
TOTAL

4

Col
d

Rigor/Stif
f

Neck
Abrasion
s

Gagge
d
Mouth

0

No
Puls
e

Eye
s

0

Pale
Ski
n

No
AED
Rhyth
m

Bodil
y
Fluids

0

0

1

1

0

0

0

0

0

0

1

0

1

1

0

1

0

0

1

0

0
0
1
0
0
0
2

0
0
1
0
0
0
1

0
1
1
1
1
1
7

0
1
0
0
1
0
4

1
0
1
0
0
0
2

0
0
1
1
1
0
4

0
0
0
0
0
0
0

0
0
0
0
0
0
0

0
1
0
1
1
0
4

0
0
0
0
0
0
0

A- 62



Chart 7: Total Physical Descriptions of Ahmed

Total Descriptions of Ahmed (ISN #693)
7
6

6

6
5

5
4
3

6

33

4

4

44

3

33

2

22

2

TOTAL DESCRIPTIONS

1

1

1
0

0

Total
Descriptions
Guards
Medics

6

5
4

2

6

000

0

1
0

MEDICS
GUARDS

Blue

Cold

Rigor/Stiff

Neck
Abrasions

Gagged
Mouth

No
Pulse

Eyes

Pale
Skin

Bodily
Fluids

0

No
AED
Rhythm
4

6

5

5

4

6

6

6

3
3

3
2

1
4

2
2

2
4

3
3

6
0

0
0

0
4

1
0

1

A- 63



Chart 8: Physical Descriptions of Ahmed By Guards Only

Physical Descriptions of Ahmed (ISN #693) by
Guards
7
6
5
4
3
2
1
0

6

3

3

?/1065/CITF
AG1 (MA/954/CITF)
AG2 (Alpha Block
Guard/964/NCIS)
AG3 (Alpha Block
Guard/968/CITF/ERF Team
Member/973/NCIS)
AG4 (Guard/982/NCIS)
Alpha Block Guard/956/NCIS
Commander (Joint Detention
Group Commander/1054/NCIS)
Echo Guard (Alpha Block
Guard/1009/CITF)
Escort Control 1
(Escort/996/NCIS)
Escort Control 2 (Escort Team
LPO/1003/NCIS)
Escort Control 3
(Escort/1015/NCIS/Escort/1044/
NCIS)
Escort Control 5
(Escort/1000/NCIS/Escort/1023/
NCIS)
Guard 1 (Alpha Block

3
2

2

1

1
0

Blu
e

Col
d

Rigor/St
iff

Neck
Abrasio
ns

1
0

0
1

0
0

0

0

0
0
0

0

No
Puls
e

Eye
s

0
0

Gagg
ed
Mout
h
1
0

0
0

Pal
e
Ski
n
0
0

No
AED
Rhyth
m
0
0

Bodil
y
Fluid
s
0
1

0
0

0

0

0

0

0

0

0

0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

1
0
0

0
0
0

0
0
0

0
0
0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

1

0

1

0

1

1

0

0

0

1

0

1

0

1

1

1

0

0

0

1
0

0
0

0
0

1
0

0
0

1
0

1
0

0
0

0
0

0
0

A- 64



Guard/1031/NCIS/Guard/1029/
CITF)
Guard 3 (?/1042/NCIS)
Sally Guard (Sally Gates
Guard/1006/NCIS/Sally Gates
Guard/1007/NCIS)
SOG (SOG/942/NCIS)
TOTAL

0

0

0

0

0

0

0

0

0

0

0
0
3

1
0
3

0
0
1

0
0
2

0
0
2

0
0
3

1
0
6

0
0
0

0
0
0

0
0
1

A- 65



Chart 9: Physical Descriptions of Ahmed By Medics Only

Physical Descriptions of Ahmed (ISN #693) by
Medical Personnel
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0

4

4

4

3

Corpsman/1088/NCIS
Corpsman/1090/NCIS
Corpsman/88/CITF
Night Shift Team
Leader/1077/NCIS
Nurse/1073/NCIS
TOTAL

3
2

2
0

Blue

Cold

1
1
0

0
0
0

0
1
3

1
1
2

Rigor/Stiff

0

Gagged
Mouth
1
1
0

No
Pulse
0
0
1

Eyes

1
1
0

Neck
Abrasions
1
0
0

1
1
4

1
0
2

1
1
4

1
1
3

0

0
0
0

Pale
Skin
0
0
0

No AED
Rhythm
1
1
1

Bodily
Fluids
0
0
0

0
0
0

0
0
0

1
0
4

0
0
0

A- 66



Chart 10: Number of Statements of Rigor Mortis

Number of Statements of Rigor Mortis
14
12

12
10

9

8

7

Al Zahrani (ISN 093)

6

6

5

Al Tabi (ISN 588)

5
4

4

Ahmed (ISN 693)

3

2

1

0
TOTAL STATEMENTS

DETAINEE
Al Zahrani
(ISN 093)
Al Tabi (ISN
588)
Ahmed (ISN
693)

GUARD STATEMENTS

MEDIC STATEMENTS

TOTAL
STATEMENTS

GUARD
STATEMENTS

MEDIC
STATEMENTS

9

3

6

12

5

7

5

1

4

A- 67




Appendix P

Binding Descriptions
Chart 1: Gagged Mouth

Number of Gagged Mouth Descriptions
12

11

10
8

6

6
4

7
5

4

3

2

1

2

1

DETAINEE 093
DETAINEE 588
DETAINEE 693

0
TOTAL

GUARDS

MEDICS

Number of Gagged Mouth
Descriptions for Al Zahrani
(ISN #093)
12
10
8
6
4
2
0

11
7
4

TOTAL

GUARDS

MEDICS

A- 68




Number of Gagged Mouth
Descriptions for Al Tabi (ISN
#588)
4
3

3
2

2

1

1
0
TOTAL

GUARDS

MEDICS

Number of Gagged Mouth
Descriptions for Ahmed (ISN
#693)
8
6

6

5

4
2

1

0
TOTAL

TOTAL
DESCRIPTIONS
Detainee 093
Detainee 588
Detainee 693

GUARDS

TOTAL
11
3
6

MEDICS

GUARDS
7
1
1

MEDICS
4
2
5

A- 69



Chart 2: Bound Neck

Number of Bound Neck Descriptions
9
8
7
6
5
4
3
2
1
0

8

5

5

5

4

DETAINEE 093

4

DETAINEE 588
2

DETAINEE 693
0

TOTAL

TOTAL
DESCRIPTIONS
Detainee 093
Detainee 588
Detainee 693

GUARDS

TOTAL

MEDICS

GUARDS
8
5
4

0

5
5
4

MEDICS
2
0
0

A- 70



Chart 3: Bound Hands

Number of Bound Hand Descriptions
9
8
7
6
5
4
3
2
1
0

8

5
DETAINEE 093

4
3

3

3

DETAINEE 588
2

DETAINEE 693
1
0

TOTAL

TOTAL
DESCRIPTIONS
Detainee 093
Detainee 588
Detainee 693

GUARDS

TOTAL

MEDICS

GUARDS
8
4
3

5
3
3

MEDICS
2
1
0

A- 71



Chart 4: Bound Feet

Number of Bound Feet Descriptions
2.5
2

2

1.5
1

1

DETAINEE 093

1

DETAINEE 588
DETAINEE 693

0.5
0

0
TOTAL

TOTAL
DESCRIPTIONS
Detainee 093
Detainee 588
Detainee 693

0

0

0

0

GUARDS

TOTAL

MEDICS

GUARDS
2
0
0

0

1
0
0

MEDICS
1
0
0

A- 72



Chart 5: Bound Torso

Number of Bound Torso Descriptions
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0

4
3

3
DETAINEE 093

2

DETAINEE 588
1

1

DETAINEE 693

0

0

0

TOTAL

GUARDS

MEDICS

TOTAL
DESCRIPTIONS
Detainee 093
Detainee 588
Detainee 693

TOTAL

GUARDS
4
0
3

1
0
1

MEDICS
3
0
2

A- 73



Table 1: Al Zahrani Data
Named Used In Report
(POSITION/PAGE #/Report) *Note:
Multiple page references refer to multiple
interviews for the same actor

AG1 (Alpha Block Guard/956/NCIS)
AG1 (MA/953/CITF)
AG2 (alpha Block
Guard/964/NCIS/Alpha Block
Guard/962/CITF)
AG3 (ERF Team
Member/973/NCIS/Alpha Block
Guard/968/CITF)
AG4 (Guard/982/NCIS/Alpha Block
Guard/978/CITF)
Alpha NCO (Block NCO/946, 948,
952/NCIS)
Commander (Joint Detention Group
Commander/1054/NCIS)
Corpsman/1075/NCIS
Corpsman/1083/NCIS
Corpsman/1090/NCIS
Detainee (?/1146/CITF)
Detainee (ISN 497/1128/CITF)
Echo Guard (guard/1011/NCIS)
EMT/1103/NCIS
EMT/1108/NCIS
ER Doctor/1113/NCIS
Escort Control 2 (Escort/1015/NCIS)
Guard 1 (Alpha Block
Guard/1031/NCIS/Guard/1029/CITF)
Guard 2 (Guard/987/NCIS)
Guard/981/NCIS
IRF Guard
(IRF/1038/NCIS/IRF/1036/CITF)
Night Shift Team Leader/1077/NCIS
Nurse/1070/NCIS
Nurse/1073/NCIS
Nurse/1093/NCIS
Nurse/186/NCIS
PL (Platoon
Leader/936/NCIS/940/NCIS)
REDACTED/1065/CITF
Redacted/1068/NCIS
Redacted/1081/NCIS
Redacted/1097/NCIS

GAGGED BOUND
MOUTH HANDS

BOUND
FEET

BOUND
TORSO

BOUND
NECK

1
1

1
0

0
0

0
0

1
1

1

1

0

0

0

1

0

0

0

1

0

0

0

0

1

1

1

1

0

0

0
0
0
0
0
0
0
0
0
0
0

0
0
0
1
1
0
1
0
0
0
0

0
0
0
0
1
0
0
0
0
0
0

1
0
0
1
0
0
0
0
0
0
0

0
0
1
0
0
1
0
0
1
1
0

1
0
1

1
0
0

0
0
0

0
0
0

0
0
0

0
0
0
0
1
0

0
0
0
0
0
0

0
0
0
0
0
0

0
0
1
0
0
1

0
0
0
0
0
0

0
1
1
0
1

0
0
0
0
1

0
0
0
0
0

0
0
0
0
0

0
0
0
0
0
A- 74



Sally Guard (Sally Gates
Guard/1006/NCIS)
SOG (SOG/942/NCIS)
TOTAL

0
0
11

0
0
8

0
0
2

0
0
4

0
0
8

A- 75



Table 2: Al Tabi Data
NAMED USED IN REPORT
(POSITION/PAGE #/Report) *Note:
Multiple page references refer to multiple
interviews for the same actor

?/1065/CITF
?/1203/CITF
AG1 (Alpha Block
Guard/956/NCIS/Alpha Block
Guard/964/NCIS/MA/954/CITF)
AG4
(Guard/982/NCIS/Guard/987/NCIS)
Commander (Joint Detention Group
Commander/1054/NCIS)
Corpsman/1083/NCIS
Corpsman/1093/NCIS
Detainee/1141/NCIS
Echo Guard (?/1011/NCIS)
Echo Guard (Alpha Block
Guard/1009/CITF)
Escort Control 2
(Escort/1003/NCIS)
Escort Control 3
(Escort/1015/NCIS)
Escort Control 4
(Escort/1019/NCIS)
Escort Control 5
(Escort/1023/NCIS)
Guard 1 (Alpha Block
Guard/1031/NCIS)
Guard 3
(MA/1041/NCIS/?/1042/NCIS)
Master of Arms/1038/NCIS
Night Shift Team
Leader/1077/NCIS
Nurse/1070/NCIS
Nurse/1074/NCIS
Nurse/184/NCIS
Redacted/1068/NCIS
Redacted/1081/NCIS
SOG (SOG/942/NCIS)
TOTAL

GAGGED
MOUTH

BOUND
HANDS

BOUND
FEET

BOUND
TORSO

BOUND
NECK

0
0

0
0

0
0

0
0

0
0

0

0

0

0

0

0

1

0

0

1

0
0
0
0
0

0
0
1
0
1

0
0
0
0
0

0
0
0
0
0

1
0
0
0
0

0

1

0

0

1

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1
0

0
0

0
0

0
0

0
1

1
0
1
0
0
0
0
3

0
0
0
0
0
0
0
4

0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
5

A- 76



Table 3: Ahmed Data
NAMED USED IN REPORT
(POSITION/PAGE #/Report) *Note:
Multiple page references refer to
multiple interviews for the same actor

?/1065/CITF
AG1 (MA/954/CITF)
AG2 (Alpha Block
Guard/964/NCIS)
AG3 (Alpha Block
Guard/968/CITF/ERF Team
Member/973/NCIS)
AG4 (Guard/982/NCIS)
Alpha Block Guard/956/NCIS
Commander (Joint Detention
Group Commander/1054/NCIS)
Corpsman/1088/NCIS
Corpsman/1090/NCIS
Corpsman/88/CITF
Echo Guard (Alpha Block
Guard/1009/CITF)
Escort Control 1
(Escort/996/NCIS)
Escort Control 2 (Escort Team
LPO/1003/NCIS)
Escort Control 3
(Escort/1015/NCIS/Escort/1044/
NCIS)
Escort Control 5
(Escort/1000/NCIS/Escort/1023/
NCIS)
Guard 1 (Alpha Block
Guard/1031/NCIS/Guard/1029/C
ITF)
Guard 3 (?/1042/NCIS)
Night Shift Team
Leader/1077/NCIS
Nurse/1073/NCIS
Sally Guard (Sally Gates
Guard/1006/NCIS/Sally Gates
Guard/1007/NCIS)
SOG (SOG/942/NCIS)
TOTAL

GAGGED
MOUTH

BOUND
HANDS

BOUND
FEET

BOUND
TORSO

BOUND
NECK

1
0

0
0

0
0

1
0

0
0

0

0

0

0

0

0
0
0

0
0
0

0
0
0

0
0
0

1
0
0

0
1
1
0

0
0
0
0

0
0
0
0

0
1
0
0

0
0
0
0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

1

1

0

0

0

0

0

1

0

0

1

0
0

1
0

0
0

0
0

1
0

1
1

0
0

0
0

1
0

0
0

0
0
6

0
0
3

0
0
0

0
0
3

0
0
4

A- 77




Appendix Q

Possible Suicide Notes
The investigations include copies of “possible suicide notes” found on the bodies of the
three dead detainees27 as well as longer “apparent suicide notes” found in the cells of other
detainees, only two of which were identified as written by the detainees who died June 10.28 All
Arabic language documents in the investigative files were accompanied by English translations
prepared by unnamed persons.29 This report did not seek to verify the translations’ accuracy, and
accepts the government’s translations as accurate.
On several of the translations, notes from the preparer indicate opinions as to the cultural
significance of the content of the documents, and most of these comments point out nonspecific
indications of death. The documents in translation do speak of the authors’ souls being ready for
whatever is to come, and other similar rhetoric (one describes Uncle Sam tightening a rope
around the writer’s neck), so it is plausible that these documents may indeed be the “suicide
notes” that the government claims them to be. However, assuming accuracy of translation, the
language in these documents could also be merely reflective of the nature of Islamic religious
writing.
Furthermore, there is no evidence in any of these documents of conspiracy between the
three dead men. At no time do any of the documents mention meeting, or planning, or
coordination of any kind. The final report simply states that the fact that all three men had
written documents in their cells and/or on their persons is an indication of conspiracy, and makes
no further attempt to support that conclusion.
It is also unknown how many other detainees were in possession of similar documents;
materials which would have been collected at the same time as those included in the
investigative files. Whether the written notes in question are suicide notes or not, their
translations provide no evidence of a conspiracy between the three dead men.




























































27

NCIS at 1239.
NCIS at 2. See NCIS at 1310–1313.
29
See SOUTHCOM 609-648, 655-663, 664-672; NCIS at 1239.
28

A- 78