GUANTANAMO BAY, Cuba – Accused war criminal Omar Khadr Thursday initially refused to attend the second day of his pretrial hearing, the first substantial military commission hearing of the Obama administration, but eventually attended despite what his lawyers called severe eye pain.

The absence of Khadr, a 23-year-old Canadian citizen captured in Afghanistan and charged with murder, conspiracy and support of terrorism, sparked a debate in the courtroom. Eventually Col. Patrick Parrish, the presiding judge, called a recess to give Khadr’s attorneys a chance to convince him to attend before he ordered Khadr to be brought to court by force.

Khadr chose to attend, but in a condition that defense attorney Barry Coburn described as severe pain.

“Mr. Khadr is showing a great deal of courage in spite of his physical condition,” he said.

Khadr is accused of throwing a grenade that killed Sgt. Christopher Speer, a Delta Force commando, during a July 2002 firefight in Afghanistan. After the fight Khadr — 15 years old at the time — was found unconscious, partly blinded by shrapnel and shot twice in the back by American forces. He was airlifted to Bagram for medical attention.

Khadr claims that, while detained at Bagram and then Guantánamo Bay, he was subjected to a variety of abuses, such as stress positions, suffocation, threats of rape and being used as “human mop” to wipe up his own urine. During those interrogation sessions, Khadr now says he told his interrogators what he thought they wanted to hear.

Debates surrounding whether or not Khadr’s refusal to attend Thursday’s hearing was voluntary filled the morning hours.

According to testimony by Marine Capt. Laura Bruzzese, a detention facility guard who spoke with Khadr Thursday morning, Khadr initially agreed to attend the hearing, but asked first to be taken to the detainee hospital because of pain in his left eye, which still contains shrapnel from the firefight and is permanently blind.

After he returned from the hospital, Khadr refused to wear the “eyes and ears,” a pair of goggles and ear muffs that obstruct a detainee’s sight and sound while in transit. According to Bruzzese, Khadr said he would not wear them because their sole purpose was to humiliate him.

Prosecuting attorney Jeffrey Groharing said Bruzzese’s testimony made clear that Khadr’s decision not to attend was voluntary rather than because he was physically unable to be there.

But Coburn argued that further testimony was needed because Bruzzese was not at the detainee hospital and because of Khadr’s medical condition and the trauma he has suffered.

Coburn asked that Dr. Stephen Xenakis, a retired Army general who has psychiatrically evaluated Khadr numerous times, testify, but Parrish denied his request.

When Parrish learned that the record from Khadr’s arraignment did not show he was informed of his right to attend voluntarily, and that if he chooses not to exercise that right the proceedings can continue without him, the judge called a recess so Coburn and fellow defense attorneys Kobie Flowers and Army Maj. Jon Jackson could make sure Khadr was fully aware of his rights and see if he would attend.

Parrish said that to ensure Khadr was fully aware of his rights, he was willing to order that Khadr be forcibly extracted from his cell and brought to the court.

When Khadr eventually arrived in court voluntarily, Coburn said his face was red and he was in so much pain that, at points, he appeared to be crying. During a post-hearing news conference, Xenakis said the goggles Khadr had objected to earlier but wore in transit to the courtroom had aggravated the pain.

Coburn and Xenakis said Khadris suffering from severe conjunctivitis, more commonly known as “pink eye,” in the eye hit by shrapnel as well as high blood pressure. Those combine to cause him severe pain that, according to Xenakis, requires further medical attention.

Navy Cmdr. Brad Fagan said that Khadr would be examined by a doctor and an optometrist Thursday evening.

During the courtroom session, as Khadr held his hands to his face, FBI agent Robert Fuller, who interrogated Khadr while he was held at Bagram Air Base in Afghanistan, returned to the stand. Fuller testified that, during interrogations at Bagram, Khadr said he had built and planted IEDs as well as been taught to fire an AK-47.

The prosecution then showed a roughly 25-minute long video which shows a young Khadr smiling and laughing while building and planting improvised explosive devices, known as IEDs. Flowers protested the showing of the video, arguing that it was irrelevant to the question of whether the statements Khadr made during interrogation were voluntarily, the subject of the particular motion being debated.

Parrish allowed the video to be played, saying he could not judge its relevance if he had not seen it.

As on Wednesday, Parrish ended the day’s proceedings promptly at 4 p.m. so Khadr could fulfill his religious obligation to pray.

After the hearing, attorneys from human rights organizations said they were shocked by the lack of consideration Parrish showed for Khadr’s physical condition while in court. “The fact that we saw such little concern from the court today is astounding,” said Alex Neve, secretary general of Amnesty International. Neve said that it is possible that the government’s treatment of Khadr Thursday amounts to abuse.