In March 2018, the U.S. government decided that five Yemeni men were so dangerous that there was only one solution: They needed to die. After a U.S. military commander gave the final sign-off, a missile ripped through their SUV, near the village of Al Uqla, and tossed the car into the air. Three of the men were killed instantly. Another died days later in a local hospital. The only survivor was Adel Al Manthari.

Al Manthari's body was ravaged. His entire left side was burned. His right hip was fractured and his left hand sustained catastrophic injuries to its blood vessels, nerves, and tendons. Despite multiple surgeries and nine months of medical treatment after the strike, he was permanently disabled. The severe burns left his skin vulnerable to infection, and his body has regularly been covered in bed sores due to his limited mobility.

The U.S. military claimed that Adel Al Manthari and the others in the vehicle were "terrorists" from Al Qaeda in the Arabian Peninsula, but independent inquiries said otherwise. There is no evidence to suggest that the United States ever reinvestigated the strike. And every day for the past four years, Al Manthari has paid the price for America's shoot-first-ask-no-questions-later system of remote warfare. The irreparable damage to his body left Al Manthari unable to walk or work, robbing him of dignity and causing his daughters — ages 8 and 14 at the time of the strike — to drop out of school to help care for him. The psychological impact of the strike has been profound, leaving Al Manthari traumatized and in need of treatment. And the financial impact has been ruinous.

Repeated surgeries and medical treatment plunged his family into debt and the bills have never ceased. While the U.S. has millions of dollars in funds earmarked for civilian victims of U.S. attacks, the military ignored pleas on Al Manthari's behalf, leaving the 56-year-old to rely on a GoFundMe campaign earlier this year to save his life. But he's back on the brink again, with more surgeries and bills, and, in an unusual move, his family agreed to share these new bills with The Intercept to provide itemized — and visceral — evidence of the financial as well as human cost of the U.S. attacking an innocent man and refusing to pay so much as a dime for his medical treatment.

Al Manthari, who is receiving treatment in Egypt, now needs six weeks of hospitalization to recover from a hip replacement ($6,266.32), a skin graft operation on his left hand and arm ($7,000.00), and at least three physical therapy sessions a week for six months ($892.95), according to Reprieve, an international human rights organization that is representing him. The total cost of these treatments is close to $23,000, which includes hospitalization and medications; fees for a surgeon, doctors, and nurses; six months of rent for an apartment in Cairo for Al Manthari and his two adult sons, who are his main caretakers now; utilities; and transport to and from physical therapy. Once again, Al Manthari's health and well-being rests with a crowdfunding campaign.

But it doesn't have to be this way.

"It is appalling that innocent people, civilians who have no connection to armed groups, are left to fend for themselves," said Aisha Dennis, project manager on extrajudicial executions at Reprieve. "It is heartening that ordinary people, particularly Americans, have stepped in to support Mr. Al Manthari where their government has failed. But it is not — it must not be — their job to do this. It is the duty of the people dropping the bombs, in this case the U.S. government, to face the wreckage they are causing to families and communities and address it with humanity."

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Adel Al Manthari, then a civil servant in the Yemeni government, is treated for severe burns, a fractured hip, and serious damage to the tendons, nerves, and blood vessels in his left hand following a drone strike in Yemen in 2018.

Photo: Reprieve

Reparations Are Rare

Al Manthari's case highlights the seldom seen devastation to the lives of drone strike survivors and their families, especially those who live in areas outside formal war zones such as Iraq and Afghanistan.

From Libya to Somalia, Syria to Yemen, the United States has left a trail of broken bodies and shattered families. Secret Pentagon investigations have shown that Hellfire missiles are often far more effective at killing people than the United States is at targeting the "right" ones. But every so often, an innocent person living in the backlands of an African or Middle Eastern nation survives a drone attack.

Since at least World War I, the U.S. military has been paying compensation for harm to civilians. During the Vietnam War, solatia payments, as they are called, were a means for the military to make reparations for civilian injuries or deaths without having to admit guilt. In 1968, for example, the going rate for adult lives was $33. Children merited half that.

At the beginning of the forever wars, activist Marla Ruzicka became a tireless advocate for war victims, founding the Campaign for Innocent Victims in Conflict (now the Center for Civilians in Conflict, or CIVIC) to advocate on their behalf and, with the assistance of Sen. Patrick Leahy, D-Vt., helped to secure tens of millions of dollars from the U.S. government for Afghans and Iraqis harmed by U.S. military operations.

Between 2003 and 2006, the Defense Department paid out more than $30 million in solatia and condolence payments to "Iraqi and Afghan civilians who are killed, injured, or incur property damage as a result of U.S. or coalition forces' actions during combat," according to the Government Accountability Office. But in more recent years, the sums paid out have plummeted. From 2015 to 2019, for example, the U.S. paid just $2 million to civilians in Afghanistan.

In 2005, after Ruzicka was killed by a suicide bomber in Iraq, a U.S. Agency for International Development program was renamed the Marla Ruzicka Iraqi War Victims Fund and began paying out tens of millions of dollars. But while the program was intended to provide assistance to Iraqis who suffered damages, injury, or death due to U.S. or coalition forces' actions, experts say it was repurposed into a more general use fund for economic development, such as promoting local businesses and youth entrepreneurship. USAID was unable to provide statistics on just how much money was paid out under the program or what percentage went to victims of U.S. attacks. A spokesperson would only speak off the record, which The Intercept declined to do.

Payouts under various compensation, solatia, and battle damage schemes have also varied widely — from $124 to $50,000, for example — for a civilian killed in Afghanistan. Basim Razzo, who survived a 2015 airstrike in Iraq that killed his wife, daughter, and two other family members and destroyed two homes he valued at $500,000, was offered a "condolence payment" of $15,000, which an Army attorney said was the capped limit. Razzo rejected it as "an insult." But after Italian aid worker Giovanni Lo Porto was killed by a U.S. drone strike that same year while being held hostage by Al Qaeda, the U.S. paid his family $1.3 million as a "donation in the memory" of their son.

While the United States provided compensation to significant numbers of Iraqis and Afghans affected by ground combat and, in certain cases, airstrikes in the first half of the so-called war on terror, more recent victims of drone attacks or the air war against Islamic State have rarely received reparations, experts say. Even those whose civilian casualty allegations have been deemed "credible" by the United States are seldom compensated.

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A doctor's note in Arabic detailing Al Manthari's need for hip replacement surgery due to a fracture suffered in a March 2018 U.S. drone attack. The total cost of the prosthetic hip and fees for the medical team was about 120,000 Egyptian pounds, or $6,451.

Photo: Obtained by The Intercept

Resorting to GoFundMe

Earlier this year, Adel Al Manthari's feet and legs blackened due to restricted blood flow, and his doctor said he was at imminent risk of developing gangrene. Unable to access the required medical care in Yemen, his family needed to get him to Egypt and, as is common in the region, pay in advance for medical care. For his treatment at Cairo's Kasr al-Aini Hospital, according to documents provided to The Intercept by Reprieve, Al Manthari paid for admission fees ($327.96); an initial surgery on his leg ulcers ($322.58), two separate bills for hospital service fees ($913.98); a biopsy ($48.39); a skin graft operation to replace burned skin, reduce swelling, and begin to restore movement to his legs ($1,129.03); a gastric sleeve surgery to facilitate his hip replacement ($2,741.94); the costs of a hospital bed, follow-up care from nurses and consultants, blood tests, X-rays, scans, and medications ($7,795.68); three weekly physical therapy sessions to prepare for his hip replacement operation ($1,075.27); a hip prosthetic ($4,838.71); a hip replacement operation ($1,612.90); and a wheelchair and folding walker ($261.10), among other expenses.

The total cost exceeded $21,000. The average per capita income in Yemen is around $2,200.

Al Manthari was in danger of losing his legs and possibly his life, both of which ended up dependent on a GoFundMe campaign that had stalled at around $8,700. Media attention, largely from The Intercept, helped spur the generosity of strangers who donated enough money for Al Manthari to pay for the surgeries he needed to keep his legs and stave off death. But that was hardly the end of the medical care that the Yemeni drone strike survivor requires. He faces a lifetime of medical bills that the U.S. government is, thus far, unwilling to pay or even acknowledge.

The exact status of Al Manthari's plea for U.S. reparations is unclear. In 2018, CENTCOM announced that it was aware of civilian casualty reports stemming from the March 29, 2018 attack that injured him and was conducting a "credibility assessment." Asked about the results four years later, CENTCOM spokesperson Lt. Col. Karen Roxberry told The Intercept, "We are not able to provide responses on this." Investigations by the Associated Press and the Yemen-based group Mwatana for Human Rights both determined that the U.S. had attacked only civilians.

In March, Sens. Chris Murphy, D-Conn., and Elizabeth Warren, D-Mass., asked Defense Secretary Lloyd Austin to open a new investigation into the airstrike that disabled Al Manthari, as well as 11 other U.S. attacks in Yemen. The Pentagon did not respond to repeated requests for comment on what actions, if any, Austin has taken in response to the request. In a letter to Murphy and Warren shared with The Intercept, Colin H. Kahl, the Pentagon's top policy official, did not even address the issue of new investigations.

"It's tragic and shameful that covering the costs of medical care for people bombed by the U.S. has fallen on crowdsourcing.

"It's really important that they look back at these cases from the last five or 10 years — especially in theaters of war, like Yemen, where they have made few acknowledgements of civilian harm," said Joanna Naples-Mitchell, a human rights attorney and director of the nonprofit Zomia Center's Redress Program, which assists survivors of U.S. airstrikes to submit requests for amends. "You can count on one hand the cases in which they've offered condolence payments in the air wars against ISIS in Iraq and Syria."

The U.S. has conducted more than 91,000 airstrikes across seven major conflict zones and killed as many as 48,308 civilians, according to a 2021 analysis by Airwars, a U.K.-based airstrike monitoring group. But only a tiny fraction have received any type of reparations. In 2020, Congress began providing the Defense Department $3 million each year to pay for deaths, injuries, or damages resulting from U.S. or allied military actions, but in the time since, the U.S. has not announced a single ex gratia payment, leaving victims like Al Manthari to fend for themselves.

"It's tragic and shameful that covering the costs of medical care for people bombed by the U.S. has fallen on crowdsourcing," Naples-Mitchell said. "Payments would be a drop in the bucket for the U.S. military, but there is clearly no system to help people. It's even unclear that allocated funding, like the USAID Marla Fund, is currently being used for that purpose."

SANAA, YEMEN - APRIL 24: Yemeni people gather in front of the parliament building during a demonstration to protest U.S. drone attacks on April 24, 2014 in the Yemeni capital of Sanaa. (Phot by Mohammed Hamoud/Anadolu Agency/Getty Images)

People gather in front of the parliament building to protest U.S. drone attacks on April 24, 2014 in Sana'a, Yemen.

Photo: Mohammed Hamoud/Anadolu Agency/Getty Images

"Under Review"

As Al Manthari's health deteriorated in the spring, Reprieve repeatedly reached out to the Pentagon and U.S. Central Command, sending them detailed evidence about his case while requesting assistance with a medical evacuation to Egypt and financial aid for urgent medical care. On September 14, while this story was being reported and five months after Reprieve first reached out, CENTCOM finally responded, noting that the documents were "under review" to "determine if the information changes the assessment of the strike." Reprieve was, however, met with silence from Austin; Anna Williams, the Pentagon's senior adviser for civilian protection; and Cara Negrette, the Defense Department's director for international humanitarian policy.

Negrette and Williams declined to speak to The Intercept. Pentagon spokesperson Lt. Col. César Santiago asked that questions be sent in writing. Those questions, submitted on May 17, have still not been answered.

The Pentagon appears to be dodging responsibility on many fronts. On May 26, Santiago told The Intercept that Negrette and Williams personally told him that they had never received any communications from Reprieve. "But they welcome any communications from Reprieve regarding this case," Santiago said. "You can provide my email and I will facilitate communications with Ms. Negrette."

On June 1, Reprieve forwarded to Negrette and Williams four messages it had sent in April, including Al Manthari's documents, and copied this reporter and Santiago. "As the matter is urgent, I look forward to your prompt confirmation of receipt and reply," Reprieve's June email said. This reporter followed up as well and was told in a June 6 email from Santiago, "I forwarded and provided the information to the appropriate office." More than three months later, according to Dennis at Reprieve, the organization has yet to hear from Austin, Negrette, Williams, or Santiago.

Reprieve also reached out to Caroline Krass, the general counsel of the Department of Defense. This reporter was CC'd on the message, which Krass read, according to a return receipt, on June 1. But Krass, said Dennis, never responded to Reprieve either.

"It's been a difficult and frustrating process. We contacted CENTCOM back on April 13, then on the first of June, the 7th of June, the 13th of July. When we finally were able to speak to someone by phone, we were told that the email was likely being blocked because it was coming from a .org.uk email address," said Dennis. "If we, as a U.S. legal action charity, cannot get a substantive response from CENTCOM, what hope do civilians harmed by U.S. drone strikes living in Somalia, Syria, or Afghanistan have to access accountability?"

While there is a formalized mechanism to contact CENTCOM concerning civilian harm allegations and millions of dollars set aside for victims, the Pentagon lacks a formal procedure in place to file claims for compensation. "There is no officially articulated process," said Naples-Mitchell, who is currently representing more than a dozen victims of civilian casualty incidents acknowledged by the U.S. military. "When I spoke with a CENTCOM lawyer, he was very clear that they did not want the public to have the perception that there is an official process. They also shy away from using the word 'claims' because, I think, they are concerned that it suggests some sort of a legal application."

"If we, as a U.S. legal action charity, cannot get a substantive response from CENTCOM, what hope do civilians harmed by U.S. drone strikes living in Somalia, Syria, or Afghanistan have to access accountability?"

Experts are hopeful that the Pentagon's new Civilian Harm Mitigation and Response Action Plan, or CHMR-AP — which provides a blueprint for improving how the Pentagon addresses civilian harm — will be an impetus for the Defense Department to remake its broken claims and compensation programs. But experts say the CHMR-AP is light on the question of accountability. Austin has also publicly stated that the Pentagon has no intention of reinvestigating past civilian harm incidents.

"The new DoD Action Plan includes some important steps towards remedying these policy failures, including improving investigation processes, recognizing the importance of amends to those harmed, and establishing a diverse menu of response options, from acknowledgements to condolence payments to the provision of medical care," said Annie Shiel, senior adviser for U.S. policy and advocacy at CIVIC. "But even if implemented effectively, it's unclear what difference those changes will make to someone like Adel Al Manthari, since the CHMR-AP doesn't include a clear commitment to looking back at the many past cases of civilian harm that have gone under-investigated, unacknowledged, and without amends."

Dennis also welcomes the CHMR-AP, with caveats, calling for increased congressional oversight of civilian casualty issues — precisely what a new congressional Protection of Civilians in Conflict Caucus has pledged to do — as well as workable mechanisms for reporting civilian harm; deadlines for responding to complaints; genuine investigations, including site visits and witness interviews (which are rarely conducted); details about how disciplinary measures and individual criminal liability will be handled; and protections for whistleblowers. "If we see all of this, we might begin to see some semblance of accountability," Dennis said.

In the four years since the Al Uqla airstrike, Al Manthari has been largely immobile and easy to find. Asked if the fact that the U.S. military has taken no further action against a man previously deemed too dangerous to live was a tacit admission that Al Manthari is — as two independent investigations found — innocent of any terrorist ties, a U.S. military spokesperson demurred. "I'll follow up with policy," he said on June 6. "I'll get back to you." He never did.

Maimed by a U.S. drone strike and abandoned to the cruel fate of crowdfunding, Al Manthari is again dependent on the kindness of strangers to get him through his next round of surgeries and follow-up care. And there's no certainty that he, or the other victims suffering in America's far-flung war zones of the last 20-plus years, will ever see the money owed to them for their losses, injuries, pain, and suffering.

"There are likely thousands of cases like Adel Al Manthari's — victims and survivors of devastating civilian harm, still waiting for any kind of acknowledgement or amends from the U.S. government," said Shiel. "Far too many cases have been erroneously dismissed despite painstaking research from human rights groups and journalists. And even when the U.S. government confirms it caused civilian casualties, it has rarely made ex gratia payments or other amends. … The result is that civil society groups and journalists have had to fill this gap, from conducting rigorous investigations the government should be doing, to setting up crowdfunding campaigns to support victims. That's just not how accountability is supposed to work."