Congress Weighs Whether to Allow Guantánamo Prisoners to Travel to the U.S. for Medical Care

With the military putting a new focus on the health care needs of aging detainees at the Guantánamo Bay prison, Congress is considering again whether to allow the Pentagon to move wartime prisoners temporarily to the United States for emergency or complicated medical care not available at the base in Cuba.

The Senate Armed Services Committee has approved a provision in a larger military authorization bill that would allow temporary medical transfers to the United States. The panel in the Republican-controlled Senate has pushed the provision for seven years, only to see it stripped from final legislation over still-strong objections from both parties to bringing foreign terrorist suspects to American territory for treatment.

The political dynamic has shifted since last year, with Democrats having taken control of the House. Representative Adam Smith of Washington, the new chairman of the House Armed Services Committee, has consistently advocated closing of the prison and relocating some detainees to the United States. A committee spokeswoman said Mr. Smith had not decided about the provision, but advocates of the proposal are hopeful that he will include it in the House version of the military authorization bill.

Even if the provision were to be included in the final bill, it is not clear that it would win approval by President Trump. The White House declined to comment. Congress has for a decade prohibited the transfer of Guantánamo detainees to the United States for any reason.

But the military's effort to highlight the challenges it faces in caring for an aging population of detainees — with no immediate prospect of the prison being closed — has given the issue new urgency.

The politics are playing out as the military seeks Congress's assistance in planning for the possibility that the last 40 prisoners held at Guantánamo from the war on terror could be there for the rest of their lives. The Pentagon has asked Congress for $88.5 million to build a wheelchair-accessible detention facility with hospice care capacity specifically for the 15 prisoners who were initially held in C.I.A. custody.

The Pentagon's request for the new prison describes the $88.5 million expenditure as for the benefit of the guards, not the detainees. If no new prison is built, it said, future inmates "bound to wheelchair and/or hospital bed" would "require guards or medical personnel to carry detainees from cell to cell placing the security and safety of U.S. personnel at risk."

But just like the proposal to allow emergency medical travel to the United States, the idea of a new prison for Khalid Shaikh Mohammed, the accused mastermind of the Sept. 11 attacks, and other so-called high-value detainees, has struck a partisan divide. In May, the House Appropriations Committee voted along party lines not to fund the new prison. Republicans wanted to fund it, the Democrats did not.

"Our military has a serious backlog on facility needs with at least 30 percent of our military infrastructure rated in fair or poor condition," said Representative Debbie Wasserman Schultz, Democrat of Florida, the chairwoman of the appropriations subcommittee on military construction. "Prioritizing a costly new facility for terrorists is not more important than our pressing military needs."

Representative John Carter of Texas was among the Republicans supporting funding for the new prison.

"Like my colleagues, I do not want to provide luxurious accommodations for detainees," he said. "But it is imperative that we provide our soldiers there the safest possible work environment. At this time we do not have that. The detainees and detention facility are an unfortunate reality. But reality it is and we need to face it."

The Obama administration had tried and failed to close the Guantánamo Bay prison. After Mr. Trump took office and signed an executive order in January 2018 that kept it open, the Pentagon began planning for 25 more years of detention, including end-of-life care.

Across the years, only two Guantánamo prisoners have been transferred to the United States. One was Yaser Esam Hamdi, who was born in the United States and challenged his military detention to the Supreme Court, and who was sent to Saudi Arabia, where he grew up, in 2004. The other was Ahmed Khalfan Ghailani, 45, of Tanzania, who was sent to New York in 2009, tried and convicted over his role in Al Qaeda's bombings of two United States Embassies in East Africa in 1998. He is serving a life sentence at a federal prison in eastern Kentucky.

No Guantánamo detainee has been brought to the United States for medical care since the prison opened in January 2002.

But the government has recognized the limitations of Guantánamo — which routinely sends American troops home for complex health care — since the Bush administration. In 2007, the State Department secretly sought to negotiate standby agreements with four Latin American countries — Costa Rica, the Dominican Republic, Panama and Mexico — to let the Pentagon take sick Guantánamo prisoners to hospitals there. It failed.

Currently, the military takes specialists, including surgical teams with sophisticated equipment, to address urgent and specialized needs at the base's small community hospital.

The problems with that approach became clear in October 2017 when, according to emails released through the courts, a visiting surgeon tried to fuse the spine at the neck of a detainee, Abd al Hadi al Iraqi. A doctor at the hospital declared the operation a failure and said the best course of action would be to transport Mr. Hadi to a naval hospital in Portsmouth, Va., "or any medical center that has the support systems in place to perform these complex procedures."

The doctor notified the prison commander at the time, Rear Adm. Edward Cashman, that the prospect of doing such a complicated operation at the Guantánamo base hospital "scares the hell out of me." Guantánamo medical personnel, at the admiral's request, then figured out what it would take to medevac Mr. Hadi from the base.

Admiral Cashman never sought permission to move Mr. Hadi, said Col. Amanda Azubuike of the Army, a spokeswoman for the United States Southern Command, which oversees the prison. She called the discussion of airlifting Mr. Hadi "part of medical mission analysis/brainstorming."

Mr. Hadi ultimately underwent five spine operations at Guantánamo, all by visiting surgical teams. He has experienced chronic pain and back spasms in the aftermath, and prison officials have set up a hospital bed at the court complex where he is to face trial on charges he commanded Al Qaeda and Taliban forces in Afghanistan in 2003 and 2004.

Raha Wala, the senior director of governmental affairs at Human Rights First, an advocacy group, said the health care transfer provision would be consistent with the Defense Department's "obligations under the Geneva Conventions to provide adequate medical care" to its war prisoners.

So far, he noted, it has never gotten further than conference committees because "Congress has not been particularly interested in having a fight about Gitmo."

This year should be different, Mr. Wala said, because Mr. Smith, the chairman of the House Armed Services Committee, has consistently sponsored amendments to lift transfer restrictions.

"As the detainees are aging, we are going to increasingly see acute medical emergencies that are going to require, frankly, treatment that isn't available at Guantánamo," Mr. Wala said. "Having the ability to be able to transfer someone out for urgent medical treatment is quite important. A detainee's life could be at risk if the authority isn't granted."