The Agony and the Irony of Guantanamo’s Mass Hunger Strike

  [Force feeding restraint chair. Image by Jason Leopold.]

The executive order pledging to close Guantánamo within a year, signed by freshly inaugurated President Barack Obama on his second day in office, is a dead letter. Over the past two months, however, the president has recommitted to his 2009 pledge, including appointing a special envoy to head the effort to break through the stalemate that is largely the product of domestic politics. Clearly, one trigger for this renewed attention to Guantánamo is the mass hunger strike among prisoners that started in February.

The Guantánamo prisoner population currently stands at 166. Eighty-six have been cleared for release. Almost four dozen others have been designated for indefinite detention because the government claims they are too dangerous to release but cannot be tried for lack of court-worthy evidence. The identities of these indefinite detainees was a closely guarded secret until 17 June 2013, when the list was released in response to a Freedom of Information Act (FOIA) request by The Miami Herald with the assistance of Yale Law School students. Of the forty-eight names on that list, which was prepared by a multi-agency task force in January 2010, two have since died.

On the same day the Herald’s request was granted, The New York Times’ FOIA request for information about the designation of all Guantánamo prisoners was also granted. According to this list, thirty-four prisoners are named as candidates for prosecution, including six whose cases are now in the pre-trial motions phase. This number is almost certain to decline on account of a 2012 federal court ruling that “providing material support for terrorism” and “conspiracy” are not a war crimes and thus cannot be pursued in a military commission. Those charges could be pursued in a federal court but for the fact that Congress passed legislation barring the transfer and prosecution of Guantánamo detainees in the US. The likely alternative is that the number of prisoners designated for indefinite detention will grow.

Getting Out Alive or Dead

More than two-thirds of the prisoners at Guantánamo—104 reportedly—are hunger striking, and forty-four are being force fed. Four have been hospitalized for causes relating to their force feeding or hunger striking. The current mass hunger strike bears many resemblances and shares some common causes to the mass strike in 2006. Some prisoners have been on hunger strike for years.

Hunger striking is a classic method used by prisoners to protest the conditions of their detention. In Formations of Violence, Allen Feldman’s study of Irish Republican Army (IRA) prisoners in British custody, he explains the politics of deliberate self-starvation: “It is not only a matter of what history does to the body but what subjects do with what history has done to the body.” The choice to exercise the limited power that protesting prisoners have—the power to refuse to eat—is, in Feldman’s words, a form of “counter-instrumentation” of their own bodies.

As one Yemeni hunger-striking prisoner wrote in a note released by his lawyer David Remes:

A human being should defend himself, but if he were to become totally unable to do so, he should take the difficult and simple decision because he has no other options. Doing so, he achieves victory over injustice and humiliation and feels his dignity as a human being.

Over a dozen of Remes’ eighteen clients are hunger striking, and four are being force fed. He provided the following narrative of the events that led to the mass strike:

When President Obama took office in 2009, he sent Admiral Patrick M. Walsh to GTMO [Guantánamo] to determine whether the prison met the standards of Common Article 3 [of the Geneva Conventions]. Predictably, Walsh reported that, yes, the camp complied with Common Article 3, but they could do even better! Thereafter, conditions in the camps markedly improved, the only creditable aspect of President Obama’s GTMO policy. The Joint Detention Group (JDG), a component of the Joint Task Force–Guantanamo (JTF), ruled with a light touch and maintained the peace—an Era of Good Feelings—until the summer of 2012.

In June 2012, JDG command passed to Colonel John V. Bogdan, one-time commander of an MP [military police] brigade that operated in East Bagdad. Unlike his Obama-era predecessors, Bogdan brought a tough-guy approach to detention operations and he has ruled the camps with an iron fist. ?Marked by displays of power for power’s sake, his approach has led to mayhem in the camps.?

In September, Bogdan, without provocation, had his men storm Camp 6 [where “compliant” detainees lived communally]. ?During the fall, conditions in the camps deteriorated: for example, temperatures in the cells were lowered to 62 [degrees Fahrenheit]. In January [2013], a tower guard in the recreation area fired into a group of detainees, wounding one,[i] and in early February, the mass hunger strike broke out.

Bogdan ??lit the fuse when he ?or one of his Officers in Charge (OIC) had the guards conduct? ?a ?sweeping search of the men’s cells in Camp 6, where about 130 of the 166 detainees were held. Guards arbitrarily confiscated personal items including family letters and photographs, legal papers, and extra blankets. ?(Civilians confiscated the papers.) Bogdan or his OICs also attempted to search the men’s Qurans, using interpreters to do the dirty work.[ii]

That fateful decision ignited the hunger strike. ?What upset the men was not how the Qurans were to be searched but the fact that they were to be searched at all. JDG had stopped searching Qurans in 2006. According to our clients, JDG has admitted that it had no concrete? reason to reinstitute Quran searches. Bogdan, however, decided to revert to the rules of 2006, which provided for Quran searches, a most provocative display of power?.

The men have offered to surrender their Qurans to the military permanently? to avoid searches. Surrendering Qurans was a common solution to threatened searches in the Bush administration days, when men feared their Qurans would be searched when they met with their lawyers. (Putting the men to that choice was one of the clever disincentives for such meetings.) Bogdan, however, will not agree to stop searches or take the Qurans.

Bogdan won’t even discuss the men’s grievances? ?until they? end their hunger strike. He’ll be damned if he blinks first. Meanwhile, he is using brutal tactics to break the strike. Many men now view the strike as a means of protesting the very fact that they continue to be held. These men, including many of my clients, say they ?are determined to ?leave Guantánamo one way or the other—alive or in a box.

Of the 130 detainees who were held in communal conditions in Camp 6, more than 100 were moved into solitary cells during a pre-dawn raid on 13 April. According to a newly-revised Standard Operating Procedure manual obtained from the US Southern Command (SOUTHCOM) and published by Al Jazeera, “in the event of a mass hunger strike, isolating hunger striking patients from each other is vital to prevent them from achieving solidarity.” But, according to Remes who spoke by telephone to one of his clients on 14 June, “the hunger strike is still going strong.”

Force Feeding

The number of prisoners being force-fed is rising as the strike endures. The American Medical Association, the International Committee of the Red Cross, and the United Nations Office of the High Commissioner for Human Rights have protested the practice of force feeding at Guantánamo as illegal and unethical.

Force feeding is a blatant contravention of the will of prisoners who have chosen to refuse food. When administered by doctors, the practice violates the World Medical Association’s (WMA) 1975 Tokyo Declaration and 1991 Malta Declaration. Luke Mitchell, formerly an editor at Harper’s Magazine who has written extensively about issues related to force feeding, provided the following account:

The British did not force [IRA prisoner] Bobby Sands to eat and so he died a martyr, which is one reason the US is so eager to force feed prisoners today. I interviewed William Winkenwerder at some length about this in 2006 [during the previous mass hunger strike at GTMO], when he was the top doctor at the Pentagon. Winkenwerder, citing the WMA 1991 declaration, suggested that force-feeding was okay—it was just up to individual doctors whether or not they wanted to participate. But that was backwards. In fact, the WMA had declared that in a case where a doctor “cannot accept the patient’s decision to refuse such aid”—that is, force feeding—“the patient would then be entitled to be attended by another physician.” In other words, all conscious patients have an absolute right to refuse “aid” when that aid is in the form of force-feeding. I read that passage to Winkenwerder, and he said “that’s new to me.”

What does all of this have to do with Sands? I asked Winkenwerder about Sands, and he said he hadn’t “studied” that case. But just a few weeks later, an unnamed Pentagon official told the Toronto Star that death by starvation was unacceptable. “The worst case would be to have someone go from zero to hero,” he said. “We don’t want a Bobby Sands.”

Why was Winkenwerder being so disingenuous? The legality of force-feeding [under US law] is vague. Federal Bureau of Prison guidelines allow it, but some specific cases forbid it.[iii] Judges can go either way. Considerable evidence suggests that it is being used as a form of torture, though. Torture is illegal, of course, and so the Pentagon has an important stake in convincing the public (and the courts) that force-feeding is an ethical medical procedure. But that requires considerable rhetorical dexterity, because the WMA is absolutely unambiguous: force-feeding is unethical.

The rhetorical dexterity includes euphemization; the practice of force feeding is officially termed “enteral feeding” or “tube feeding.” Prisoners who absolutely refuse to be fed may be strapped to “restraint chairs” which were imported to the facility during the 2006 strike and in design resemble electric chairs. Some who wish to strike but are faced with the prospect of violent cell extraction and the chair “consent” to having the tube inserted into their noses and the Ensure pumped into their stomachs. According to spokesperson Durand, “Passing out constitutes consent to a tube feeding.”

Apparently, President Obama did not get the memo on the official preference for euphemism. On 23 May he delivered a major national security speech (the second in his entire term in office) in which he spoke about the hunger strike at Guantánamo as a crisis and a policy failure: “Look at the current situation, where we are force-feeding detainees who are holding a hunger strike. Is that who we are? Is that something that our Founders foresaw? Is that the America we want to leave to our children?”

At a press conference on 4 June, Marine General John F. Kelly, the commander of SOUTHCOM, took issue with the president’s statement. “We don’t force-feed right now at Gitmo.” Rather, troops “enterally feed” hunger strikers. White House National Security spokesperson Caitlin Hayden was asked whether Obama would retract his remarks about forced feedings. “The President’s comments stand.”

Journalists Are the Eyes of the World

In March, one month into the strike, The Miami Herald’s Carol Rosenberg reported on a tour of Camp 6 during which she and other journalists witnessed prisoners refusing food. A Guantánamo spokesperson, Navy Captain Robert Durand, responded to media queries by stating that the hunger strike is “specifically designed” by the prisoners to “attract media attention.”

Rosenberg reported on the array of answers provided to journalists about why the prison military and medical staff would not permit prisoners to refuse to eat:

• It’s not humane. The motto of the 1,700-strong detention center staff…is “Safe, Humane, Legal, Transparent.” And the answer from an Army captain named John, the officer in charge of Guantánamo’s communal Camp 6, was that the military couldn’t let detainees starve themselves to death because “that would be inhumane. They can choose not to eat but we’re not going to let them starve.”
• “First, do no harm” is the creed of medical professionals, and to let a captive starve is at odds with US military medicine. A Navy lieutenant commander wearing a nameplate with the moniker Leonato put it this way: “We’re obligated to protect life. I signed on as a nurse not to carry a rifle but to keep people alive, render medical care. I’m here to deliver therapeutic care as a mental health professional.”
• It’s un-American. “Allowing a detainee to harm himself is not only counter to our responsibilities under the laws of war, but is anathema to our values as Americans,” says Army Lt. Col. Todd Breasseale, the Pentagon spokesman responsible for detention and legal issues. “Allowing a peacefully protesting detainee to harm himself by choosing to sit by while he starves himself to the point of endangering his life is not only a violation of the very code followed by civilized peoples everywhere, but it is the worst kind of victor’s justice: repugnant and wholly unacceptable.”
• It looks bad. “It’s our job to take care of them, to feed them and take care of their needs,” says Zak, the Arab-American cultural advisor to the admiral in charge of the detention center, who like nearly everybody who works there grants interviews on condition that his full name not be published. “Otherwise they will say we killed them, [or] let them die.”
• It’s policy. That’s [the answer provided by spokesperson] Durand…

Journalists currently reporting from Guantánamo are not taken on prison tours, except the abandoned Camp X-ray. According to Truthout’s Adam Hudson, the explanation offered by the JTF spokesperson is that the military commissions and the prison are separate issues, and journalists are there to report on the former. Rolling Stone’s John Knefel reports that journalists who want to tour the prison must schedule a separate expedition to the island and, according to a Pentagon spokesperson, “We’re booked up until mid-fall and possibly beyond.”

The Math and Chemistry of Strike Breaking

The Standard Operating Procedure manual, which went into effect on 5 March, details the “general algorithm” for assessing hunger strikers. Al Jazeera’s Jason Leopold writes:

Prisoners are designated as hunger strikers, according to the guidelines, if they communicate, “either directly or indirectly (i.e.: repeated meal refusals) his intent to undergo a hunger strike or fast as a form of protest or demand attention,” or if they miss nine consecutive meals and their body weight falls below 85 percent of either previous or ideal weight—usually calculated using the median BMI [body mass index] for a prisoner’s height.

The manual also describes the “chair restraint system clinical protocol” for personnel who administer the force feeding. The medical personnel, who serve under Guantánamo Commander John Smith, have no professional autonomy according to the manual.

A prisoner selected for force feeding undergoes the following procedures: First, he is offered one last chance to eat voluntarily before being put in the restraint chair. If he does not consent to eat, the “medical provider signs [the] medical restraint order.” Then a guard shackles the prisoner and places a mask over his mouth to prevent spitting and biting. A feeding tube is inserted through his nose. Medics use a stethoscope and a test dose of water to check that the tube has descended all the way to his stomach. When the tube has been secured with tape, “the enteral nutrition and water that has been ordered is started, and flow rate is adjusted according to detainee’s condition and tolerance.” The feeding can be completed in twenty to thirty minutes but might take up to two hours. After the “nutrient infusion” is completed, he is placed in a “dry cell” and observed for up to sixty minutes for any “indications of vomiting or attempts to induce vomiting.” If he vomits, he can be put through the whole process again.

If this coercive hunger management process were not appalling enough, another revelation contained in the manual is the authorization of a controversial drug to “enhance digestion” that may cause serious and permanent neurological disorders. Al Jazeera’s Leopold reports:

Metoclopramide, commonly known by its brand name Reglan, is supposed to speed up the digestive process and remove the urge to vomit during force feeding. However, medical studies into the drug have determined that Reglan also is linked to a high rate of tardive dyskinesia (TD), a potentially irreversible and disfiguring disorder characterized by involuntary movements of the face, tongue, or extremities.

The studies prompted the FDA [Food and Drug Administration] in February 2009 to slap Reglan with a black box label—the agency’s strongest warning—to inform patients about the dangers associated with chronic use of the drug. According to the FDA’s own medication guide, additional side effects include depression, thoughts about depression and, in extreme cases, suicidal thoughts and suicide.

The lack of consent in force feeding as well as the involuntary administration of Reglan and other drugs is medical malpractice. That some of the drugs prisoners are forced to ingest or are given unaware have potentially harmful side effects borders on human experimentation, especially given the stern FDA warnings.

On 30 May, fourteen prisoners wrote an open letter to the Guantánamo medical staff protesting their treatment and requesting access to independent doctors. “Dear doctor,” they wrote:

You may be able to keep me alive for a long time in a permanently debilitated state. But with so many of us on hunger strike, you are attempting a treatment experiment on an unprecedented scale…Whether you remain in the military or return to civilian practice, you will have to live with what you have done and not done here at Guantánamo for the rest of your life.

The prisoners’ letter was endorsed in an open letter to President Obama from dozens of doctors and other health professionals. They urged that independent professionals be granted full access to hunger striking prisoners and their medical records.

Beyond the Walls

In any context, there are certain commonalities in the willful decision of prisoners to go on hunger strike to protest some aspect(s) of their detention. They have chosen, whether individually or en masse, to use the one resource they have—their bodies—to wage their struggle. That choice, that power, that agency to starve contradicts and confronts the power of their custodians.

However, context matters—and differs—greatly in how the striking prisoners connect or appeal to constituencies beyond the prison walls. For example, IRA prisoners were already constituted as part of a collective political force with a shared history when they were imprisoned by the British. They regarded their cause to liberate and reunify Ireland as just, themselves as soldiers, and the method of armed struggle as justified. Their politics and activities were treated as crimes rather than war by the British. IRA prisoners’ core grievance was the refusal of their custodians to treat them as prisoners of war.

The hunger strike of 1981 in which Sands and nine other IRA prisoners starved themselves to death was the culmination of years of strikes. First was the “blanket strike” in which they refused to wear the prison uniforms of common criminals and opted instead to go naked or wear blankets. Then was the “dirty strike” in which they protested violence and abuse meted upon them by guards during “slop outs.” They responded by refusing to leave their cells to shower and smeared their walls with excrement and, in the case of female prisoners, menstrual blood.

Striking IRA prisoners were connected to the constituency of Northern Irish nationalists as well as sympathizers beyond the shores of Ireland. Their sacrifices and suffering had galvanizing effects on those constituencies and were seen as one dimension of a larger common cause.

Prisoners at Guantánamo share almost none of these aspects. They come from many countries, although all are Muslims. What they share with each other is not a common cause but rather a common experience of protracted detention without trial, and harshly abusive and degrading treatment. They are imprisoned not in their own homeland but on a faraway and inaccessible island. They are cut off from their families, and many of their home governments are indifferent or worse to their treatment. The only allies they can actually access are their attorneys, who are hamstrung by gag orders and overweening security measures. One has only to read the first-person accounts collected in The Guantanamo Lawyers, edited by Jonathan Hafetz and Mark P. Denbeaux, to appreciate how fragile and fraught lawyer-client relations at that prison can be.

There is no “natural” or national constituency politically predisposed to care about the well-being of Guantánamo prisoners, unless one counts human rights lawyers and activists and some progressive journalists as a constituency. Under these circumstances, there is a particular kind of political challenge to draw attention to the sacrifice of a mass hunger strike and the agonies caused by custodians bent on breaking it. Doctors’ organizations have stepped up, especially in response to force feeding.

For the hunger strike to make meaning beyond the prison walls in ways that would benefit the striking prisoners and address their grievances, what is needed is a constituency that sees the politics of Guantánamo and the fate of its prisoners as their cause. Such a constituency with the political muscle and determination to bring pressure to bear on those responsible for the situation at Guantánamo has yet to emerge. The hunger strike provides new urgency to the cause of closing the prison. This is summed up perfectly in the title of one US-based activist organization: “The World Can’t Wait!”

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[i] Carol Rosenberg elaborates on the shooting incident: “The irony is the facility was built with remote-controlled gates to alleviate guards from escorting captives to the recreation yard. Less contact caused less friction, was the explanation. So each side could keep to itself. But then a detainee scaled a fence to get the attention of a guard in a tower, and a guard pointed his rifle at him. The captive climbed down immediately, but other captives saw the guard with the rifle and hurled rocks at him. A ricocheting rubber pellet struck a Taliban elder in the throat, according to both military and attorney accounts, but he was not hurt enough to merit hospitalization.”

[ii] This refers to a 2006 Standard Operating Procedure rule that bars uniformed members of the military from touching Qurans. All Quran touching is supposed to be done by civilian linguists who accompany soldiers on searches.

[iii] On 19 June 2013, Senator Dianne Feinstein sent a letter to Secretary of Defense Chuck Hagel in which she elaborates on how the force-feeding procedures at Guantánamo do not resemble or comply with Federal Bureau of Prisons guidelines.

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