An Iraqi prisoner who has pleaded guilty to war crimes is recovering from emergency surgery on his spine and related complications at Guantánamo Bay, according to legal filings, in a case that illustrates the challenges of caring for ailing and aging detainees at the remote U.S. Navy base in Cuba.
The operation was the sixth for the prisoner, Abd al-Hadi al-Iraqi, who is in his 60s, at the outpost since 2017. The base typically sends U.S. service members and other residents to the United States for complex care. But Congress has forbidden the transfer of the 35 men held there as war prisoners to the United States for any reason.
A neurosurgical team fixed screws, added titanium cages and removed rods inserted into Mr. Hadi’s back in a lengthy operation on Nov. 12, according to a court filing by a prison doctor. The prisoner required blood transfusions during the procedure and suffered an unintended tear in his spinal cord. The doctor described the tear as a “common complication” and said a neurosurgeon plugged it with a muscle graft, suture and seal.
The doctor included the account in a filing for the judge in the case of Mr. Hadi, who has pleaded guilty to war crimes charges related to lethal attacks on allied soldiers in 2003 and 2004 in Afghanistan, where he had been a co-conspirator with Osama bin Laden and other top Qaeda leaders. His sentencing has been postponed until 2024 but could include a transfer to another country; his Pentagon-paid lawyer has been traveling overseas in search of a nation to receive him and provide him lifelong medical care, according to court filings.
The case has highlighted the constraints of so-called expeditionary medicine — the practice of mobilizing specialists and equipment to Guantánamo’s small Navy hospital specifically for the prison population.
This past year, the Pentagon sent a mentally ill prisoner back to Saudi Arabia for treatment and repatriated the prison’s eldest detainee, a 75-year-old Pakistani man with heart disease who had refused a Pentagon proposal to undertake a first ever cardiac catheterization at the prison.
Lawyers for other detainees, citing medical experts, say some of the prisoners who have spent more than two decades in U.S. captivity are increasingly in need of complex health care — including treatment for brain injuries and gastrointestinal problems blamed on their abuse in their earliest years of detention. Prison doctors have described the detainees as having a range of typical geriatric conditions, including diabetes and high blood pressure, as well as depression and other mental illnesses.
A native of Iraq who also obtained Afghan citizenship during the rule of the Taliban, Mr. Hadi has been held by the United States since the C.I.A. took custody of him in Turkey in 2006. He has long suffered degenerative disc disease in his spine, a condition that became acute in 2017 when guards discovered him incontinent in his cell. Five surgeries followed at Guantánamo in less than a year.
Doctors had for some time proposed to do this month’s surgery on a nonemergency basis. But the situation became urgent on Nov. 7, when Mr. Hadi told prison staff that he had lost feeling below his spine.
Mr. Hadi was at risk of permanent paralysis, his lawyers said in a statement, based on consultation with a practicing neurosurgeon. In a U.S. setting, the lawyers said, quoting their expert, he would have been rushed into surgery the day his condition was discovered. But a team and equipment needed to be mobilized to Guantánamo. So the procedure took place five days later.
The prison doctor’s account filed with the court did not characterize the length of the operation, or whether it was a success. It noted that the surgery team had stayed afterward to monitor the progress of the prisoner, who fainted from pain the day after the operation when military medical staff members tried to get him on his feet to begin a rehabilitation process expected to last months.
A Pentagon spokesman, Lt. Col. Cesar H. Santiago, declined to comment on the emergency and outcome of the surgery, citing privacy considerations.
While the prisoner’s name has been made public in court filings, the identities of the surgeon and other medical staff responsible for Mr. Hadi’s care have never been disclosed. The prison doctor wrote in his court filing that his name was being withheld from the public to protect himself and his family from potential threats.
Mr. Hadi’s next court hearing is scheduled for Feb. 13.