GUANTÁNAMO BAY, Cuba — The U.S. military has drawn up plans to replace the base hospital at Guantánamo Bay with a new $435 million health care center that would provide care for hundreds of prison guards but appears to lack facilities specifically for aging war prisoners.
The current two-story hospital, which was built in 1954, is the only health care option for the outpost’s 5,500 to 6,000 residents. In the future, more patients will be evacuated to U.S. hospitals for treatment, though by law the 35 prisoners now there cannot be taken to the United States for any reason.
Details of the “Ambulatory Care Center” were contained in a 3,000-page prospectus that the Navy circulated for would-be contractors this year. The next step will be for Congress to approve $187 million for the first stage, construction, in the fiscal year 2024 budget.
The proposal illustrates the ad hoc nature of planning and construction for the Pentagon prison operation, which opened 20 years ago and has held 780 detainees.
In 2018, for example, the Pentagon purchased an oversize holding cell and equipped it with a shower and a bed so that a prisoner could spend nights at the war court compound. However, the commander of the guard force, Col. Matthew Jemmott, testified last week that he did not have enough guards to staff it overnight.
The Biden administration has stated a goal of seeking to close detention operations, and the military has been reducing the prison staff. After the colonel testified, the U.S. Southern Command said there were 1,000 U.S. troops and other U.S. government employees working for the prison commander, 500 fewer than in April, or 28 guards and other personnel for each detainee.
A chart in the clinic proposal projects that prison staffing in 2029, when the new hospital is up and running, will be at the same level as early in the administration of Donald J. Trump, who vowed to refill the prison but did not add any detainees. Estimates then were of about 1,800 troops and civilians.
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Construction is underway on a $115 million dormitory for 848 National Guard soldiers on nine-month assignments at the prison. It was funded by Congress in 2017. But there are no longer that many prison guards at the base, according to Defense Department officials with knowledge of staffing levels. The prison staff includes hundreds of Navy medics, Coast Guard forces, civilian contractors and Army officers, who have separate housing.
A new, prefabricated $4 million courtroom is also being built and should be ready next year in case two military judges happen to hold jury trials at the same time in the three existing cases.
The court was initially designed to exclude the public. But the court administration changed course, and workers are installing a spectators’ gallery.
The proposal for the new health center described the current hospital as “at significant risk of catastrophic failure.” But Peter J. Graves, a spokesman for the Defense Health Agency, said concerns about “critical structural deficiencies” contained in a 2018 engineering study have “been remediated.”
“Barring some unforeseen extreme weather or systemic event, and recognizing the facility will need ongoing repairs, the facility is still functional and operational,” he said.
Mr. Graves said the $435 million total covered construction, equipment and the cost of operating the center for 30 years.
Dr. Stephen N. Xenakis, a psychiatrist and retired Army brigadier general, reviewed the plan and said the Pentagon was planning a “typical primary care community clinic, a facility with a couple of beds and an operating room but not intended to support more complicated treatment and procedures, which the detainees may need.”
He said the plan did not include a nursing home or assisted living facility for the detainees, who, “as they age, are likely to require more intensive and specialized treatment that has not been factored into the planning.”
Also missing from the plan, he said, are a catheterization lab, a site for M.R.I.s, capacity to offer chemotherapy or radiation therapy for cancer, and a sophisticated telehealth capacity.
In the 1990s, Dr. Xenakis was the commanding general of Army medical facilities in the southeastern United States and had oversight of the construction of several military medical projects. He has been visiting Guantánamo for more than a decade and has spoken about the military’s inability to care for prisoners there.
Because the law forbids the military to bring prisoners to the United States for care, the Pentagon sends doctors, equipment and members of the support staff to perform complex procedures on detainees at the base hospital. Residents go to Navy facilities in the United States to see specialists.
This year, the military rushed a neurosurgical team to conduct spinal surgery on the oldest detainee at Guantánamo Bay, Abd al-Hadi al-Iraqi, who is in his 60s and pleaded guilty to war crimes charges.
Prison doctors have said the detainees have a range of typical geriatric conditions, including diabetes and high blood pressure, as well as depression and other mental illnesses.
Lawyers, citing medical experts, say some of the prisoners also require treatment for brain injuries and gastrointestinal problems blamed on their abuse in C.I.A. detention. Khalid Shaikh Mohammed, who is accused of being the architect of the Sept. 11 attacks, will be 65 years old in 2029. He was waterboarded 183 times, and his lawyers have said that scans of his brain reveal damage that they suspect is related to torture.
The Trump administration ruled out a proposal to replace a failing prison building for former C.I.A. prisoners with a new facility with capacity for end-of-life care. Instead, the military shut down the site in 2021 and moved the prisoners to a 20-year-old maximum-security prison. It offers some health care, including dental services, and has a psychiatric unit with a padded cell.
The plan for the new facility says that health care “beneficiaries” will include uniformed forces assigned to the prison and court operation, but it does not specifically mention care for the detainees.
A Pentagon spokesman declined to address the lack of mention of detainee health care in the new facility, which is planned for the busy commercial center of Guantánamo, up the road from the base McDonald’s.
“The United States is focused on responsibly reducing the detainee population and ultimately closing the Guantánamo Bay detention facility,” Lt. Col. Cesar H. Santiago said in a statement. “The Department of Defense remains committed to providing appropriate medical care, in accordance with the law, to military personnel, dependents and detainees located at Naval Station Guantánamo Bay.”
Like the old hospital, the new facility will offer pediatric care for the children of officers and civilian contractors who are allowed to bring their families to Guantánamo Bay. But expectant women would leave the island in Week 34 to 36 of their pregnancy, under a U.S. military policy called “storknesting” that is used at small, lesser-equipped overseas outposts.
In a base baby boom in 2018, 57 babies were born at Guantánamo Bay.