Hunger striking Guantanamo prisoners who are force-fed a liquid nutritional supplement undergo a brutal and dehumanising medical procedure that requires them to wear masks over their mouths while they sit shackled in a restraint chair for as long as two hours, according to documentation obtained by Al Jazeera. The prisoners remain this way, with a 61cm - or longer - tube snaked through their nostril until a chest X-ray, or a test dose of water, confirms it has reached their stomach.
At the end of the feeding, the prisoner is removed from the restraint chair and placed into a “dry cell” with no running water. A guard then observes the detainee for 45-60 minutes “for any indications of vomiting or attempts to induce vomiting”. If the prisoner vomits he is returned to the restraint chair.
That’s just a partial description of the “chair restraint system clinical protocol” which medical personnel are instructed to follow when administering a nutritional supplement to prisoners who have been selected for force-feeding by Guantanamo Commander Rear Admiral John Smith.
The restraint system, published here for the first time, along with the feeding procedures policy, was contained in a newly revised Standard Operating Procedure (SOP) for Guantanamo hunger strikers, obtained exclusively by Al Jazeera from United States Southern Command (SOUTHCOM), which has oversight of the joint task force that operates the prison.
The 30-page manual contains the most detailed descriptions to date pertaining to the treatment of hunger strikers and prisoners who undergo force-feedings. The SOP replaced a previous SOP issued in 2003 - revised in 2005 - which was declassified several years ago by the Pentagon, albeit with redactions. The new, unredacted policy obtained by Al Jazeera went into effect March 5 - one month after Guantanamo prisoners launched their protest over the inspection of their Qurans.
The procedure appears to have been revised and implemented in order to deal with a mass hunger strike.
“Just as battlefield tactics must change throughout the course of a conflict, the medical responses to GTMO detainees who hunger strike has evolved with time,” says the SOP. “A mass hunger strike was successfully dealt with in  by utilising procedures adopted from the Federal Bureau of Prisons and the approach delineated in this SOP.
“However, the composition of the detainee population, camp infrastructure, and policies has all undergone significant change since the initial version of this SOP… Much of the original instruction has been retained in the form of enclosures. In the event of a mass hunger strike, these enclosures can be utilised as they have proven efficacy under mass hunger strike conditions.”
The SOP notes that there are a number of prisoners who have been hunger striking since 2005, who have “proven their determination”, and whose physical frailty have limited Guantanamo authorities’ “options for intervention”. The document goes on to say, “in the event of a mass hunger strike, isolating hunger striking patients from each other is vital to prevent them from achieving solidarity”.
On April 13, guards staged a predawn raid at the communal camp and isolated more than 100 prisoners into single cells in an attempt to bring an end to the protest.
Leonard Rubenstein, a lawyer at the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Heath and the Berman Institute of Bioethics, who reviewed the SOP document for Al Jazeera, said the revised guidelines were troubling because they prohibit doctors and nurses from acting independently and make clear that they are simply “adjuncts of the security apparatus”.
Indeed, the SOP says that in order to effectively manage hunger strikers, a “close partnership” must exist between the Joint Medical Staff and the Joint Detention Group security force. Rubenstein characterised such a relationship as “Orwellian”.
“It is a very frightening idea that the medical staff is an adjunct of the security force,” Rubenstein said. “The clinical judgment of a doctor or a nurse is basically trumped by this policy and protocol. Doctors are not acting with the kind of professional medical independence [they should]. It’s clear that, notwithstanding references to preservation of detainee health in the policy, the first interest is in ending the protests.”
Rubenstein pointed out the SOP does not provide any direction to medical personnel on how to deal with prisoners who may be suffering from a mental health condition.
Currently there are at least 100 prisoners who are on hunger strike, although some prisoners’ lawyers say that number is much higher.
[…] In a letter sent to Secretary of Defense Chuck Hagel last month, American Medical Association President Dr Jeremy Lazarus said the force-feeding procedure at Guantanamo “violates core ethical values of the medical profession”.
“Every competent patient has the right to refuse medical intervention, including life-sustaining interventions,” Lazarus wrote. “The AMA has long endorsed the World Medical Association Declaration of Tokyo, which is unequivocal on the point: ‘Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially.’”
The United Nations has condemned force-feeding as both a form of torture and a breach of international law. [READ]