During his time in captivity, the weight of the 55-year-old Egyptian has nearly doubled, reaching more than 420 pounds at one point, and his health has deteriorated as a result, both his lawyers and government officials concede.
Lawyers for El-Sawah, and the doctors they have brought down to the U.S. base in Cuba to examine him, paint a dire picture a morbidly obese man with diabetes and a range of other serious ailments. He is short of breath, barely able to walk 10 feet, unable to stay awake in meetings and faces the possibility of not making it out of prison alive.
"We are very afraid that he is at a high risk of death, that he could die at any moment," said Marine Lt. Col. Sean Gleason, a military lawyer appointed to represent him.
Details about the condition of El-Sawah, who has admitted being an al-Qaida explosives trainer but is no longer facing charges, are emerging in a series of recently filed court motions that provide a rare glimpse into the health of an unusual prisoner, and a preview of arguments that may become more common as the Guantanamo Bay prison ages into a second decade with no prospects for closure in sight.
He's not the only one of the 164 prisoners at Guantanamo who is seriously ill. Last week, a judge ordered the release of a schizophrenic Sudanese man who spent much of the past decade medicated in the prison psych ward. His lawyers argued he was so sick, with ailments that also included diabetes, that he couldn't possibly pose a threat and therefore the U.S. no longer had the authority to hold him. The judge's ruling came after the government withdrew its opposition to his release.
There's also a Pakistani prisoner, Saifullah Paracha, with a heart condition serious enough that the government brought a surgical team and a mobile cardiac lab to the U.S. base in Cuba to treat him, at a cost of $400,000. He ultimately refused the treatment because he didn't trust military medical personnel.
In addition, two prisoners have died from natural causes one from a heart attack, the other from cancer. And several detainees have raised medical complaints related to their participation in a long-running hunger strike, which had dropped to 17 prisoners as of Monday from a peak of 106 in July.
"There are a whole slew of people with a whole slew of serious health problems," said Cori Crider, a lawyer for the British human rights group Reprieve who has been meeting with Guantanamo prisoners for years.
U.S. officials say Guantanamo prisoners get excellent medical care, saying proudly that it's equivalent to what troops receive. There are more than 100 doctors, nurses and other professionals treating "a constellation" of illnesses, said Navy Capt. Daryl Daniels, a physician and the chief medical officer for the detention center. He says none is in critical condition at the moment.
"They are an aging population and they are starting to show some signs of being an older group of people," Daniels said.
In August, lawyers for El-Sawah filed an emergency motion with a federal court in Washington asking a judge to order the military to provide what it calls "adequate" medical care, including additional tests for possible heart disease and a device to help him breathe because of a condition they say is preventing his brain from receiving enough oxygen.
The government insists he is getting good care at Guantanamo and just needs to exercise more and eat less. "While (El-Sawah) is currently in poor health, his life is not in imminent danger," lawyers for the Justice Department wrote in response.
The judge hasn't ruled, but the request is secondary anyway. What El-Sawah and his lawyers want is for the U.S. to release him, preferably back home to Egypt. They argue in part that his health is too poor for him to pose any kind of threat. "It boggles the mind that they are putting up a fight on releasing him," Gleason said.
El-Sawah, who is 5 feet, 10 inches, was around 215 pounds when he arrived at Guantanamo in May 2002 after his capture in Afghanistan. Photos from before his capture show a man with a bit of girth but not in apparently ill health. One of his lawyers, Mary Petras, says he was obese by the time she first met him in March 2006.
"When he first got to Guantanamo 11 years ago he was not obese," Gleason said. "And during those 11 years he was under the custody, control and medical supervision of the United States government."
El-Sawah at one point faced charges of conspiracy and providing material support for terrorism. The government withdrew those charges and told his lawyers that prosecutors had no intention of filing them again for reasons that have not been made public. He has reportedly cooperated with interrogators and court documents contain redacted passages dealing with his time in custody but his lawyers decline to comment on the issue.
His lawyers hope to either to win a ruling either from the court or from a review board of government officials that will be re-evaluating the prisoners in custody. El-Sawah has received letters of recommendation from three former Guantanamo commanders, a rare, if unprecedented, string of endorsements.
In one letter, retired Army Maj. Gen. Jay Hood called him a unique prisoner who was "unlike the violent Islamic extremists who formed much of the population at Guantanamo." Another, Rear Adm. David Thomas, noted his "restricted mobility due to obesity and other health issues" in recommending his release.
Most striking is a letter from an official whose name and job title are redacted for security reasons. He spent several hours a week with the prisoner over 18 months at Guantanamo and says El-Sawah has been "friendly and cooperative" with U.S. personnel. "Frankly, I felt Tarek was a good man on the other side who, in a different world, different time, different place, could easily be accepted as a friend or neighbor."
Associated Press writer Ben Fox reported this story from Miami and at the Guantanamo Bay Naval Base, Cuba.