The Sanitized Horrors of Guantánamo Bay The U.S. has adopted the practice of force-feeding detainees

by Keith Barratt ("Welshman")
25 February 2006

The United States and Iran share an expression of public opinion, one that still causes considerable distress to the majority of British:

[In 1997] the people of Hartford, Connecticut, dedicated a monument to Bobby Sands and the other Irish Republican Army hunger strikers.... The monument stands in a traffic circle known as “Bobby Sands Circle,” at the bottom of Maple Avenue near Goodwin Park. The Iranian government named a street in Tehran after Bobby Sands. (It was formerly Winston Churchill Street.) It runs alongside the British embassy.

Readers may or may not be familiar with this part of Northern Ireland’s history, involving the death through a hunger strike of the IRA detainee. Bobby Sands was 27 years old when he died, 5 May 1981, after 66 days without food. Nine other IRA prisoners died following him in the same strike. Sands and his fellow strikers were protesting their reassignment from political prisoner status back to criminal status; poltical status was won the previous year through a hunger strike. Sands was elected to Parliament several days after he began his protest. The British government’s unwillingness to concede to the prisoner’s demands during the second strike, which led to the death of Bobby Sands and the other detainees, resulted in much greater sympathy for the IRA from Irish nationalists and greatly strengthened the movement as well as earned recognition from people around the world. A further brief summary is given by the Cain Institute.
– http://cain.ulst.ac.uk/events/hstri...

Before discussing the aspect of force-feeding that is taking place now in U.S. prisons, I want to step back a bit further into British history. I first became aware of the question of force-feeding through an excellent BBC docudrama many years ago about suffragettes, who employed civil disobedience
in the UK from 1900 to 1920 in order to achieve the vote for women.

Many were imprisoned and used hunger strikes to further their cause. The authorities could not let these women, many of whom were connected to leading families in the country, die and become martyrs. They were forcibly fed.

The BBC did not hide what this meant in their dramatization of the events. They showed the women being bound to chairs, their heads pulled back by their hair, and the rough-handed prison warders thrusting large-diameter rubber tubes down their throats and pouring in a food mixture through a funnel.

So that you take what follows as seriously as you take all other acts now being done in our name, I ask you to sense the ugliness of the abuse, your mouth being forced open, the taste of that tube, and the abomination of the act. For surely we have become so accustomed to these atrocities that our newspapers can discuss them calmly and objectively. But you can no more be objective about these horrors than you can calmly debate in Congress where and when torture might be acceptable.

Yet what follows is classified not as torture but as “prisoner welfare.” Constance Lytton was force-fed in October 1909. Her book Prison and Prisoners included an account of her experiences:

Two of the wardresses took hold of my arms, one held my head and one my feet. The doctor leant on my knees as he stooped over my chest to get at my mouth. I shut my mouth and clenched my teeth.... The doctor seemed annoyed at my resistance and he broke into a temper as he pried my teeth with the steel implement. The pain was intense and at last I must have given way, for he got the gap between my teeth, when he proceeded to turn it until my jaws were fastened wide apart. Then he put down my throat a tube, which seemed to me much too wide and something like four feet in length. I choked the moment it touched my throat. Then the food was poured in quickly; it made me sick a few seconds after it was down. I was sick all over the doctor and wardresses. As the doctor left he gave me a slap on the cheek. Presently the wardresses left me. Before long I heard the sounds of the forced feeding in the next cell to mine. It was almost more than I could bear, it was Elsie Howley. When the ghastly process was over and all quiet. I tapped on the wall and called out at the top of my voice, “No Surrender,” and then came the answer in Elsie’s voice, “No Surrender.”

As is happening now in Guantánamo Bay, nasal insertion was also employed. Mary Leigh, a member of the WSPU, was forced-fed in September 1909:

On Saturday afternoon the wardress forced me onto the bed and two doctors came in. While I was held down a nasal tube was inserted. It is two yards long, with a funnel at the end; there is a glass junction in the middle to see if the liquid is passing. The end is put up the right and left nostril on alternative days. The sensation is most painful - the drums of the ears seem to be bursting and there is a horrible pain in the throat and the breast. The tube is pushed down 20 inches. I am on the bed pinned down by wardresses, one doctor holds the funnel end, and the other doctor forces the other end up the nostrils. The one holding the funnel end pours the liquid down - about a pint of milk... egg and milk is sometimes used.

Emmeline Pankhurst, who was then in her fifties, endured 10 hunger strikes. Kitty Marion underwent at least 200 force-feedings in prison while on hunger strike. Emmeline Pankhurst’s sister, Mary Clarke, was taken ill at her home in Brighton soon after release from prison and died of a broken blood vessel, probably as a result of being forced-fed in Holloway Prison.

In Parliament James Keir Hardie, one of the founders of the Labour Party, said:
In reply to a question of mine today, Mr. Masterman, speaking on behalf of the Home Secretary, admitted that some of the nine prisoners now in Winston Green Gaol, Birmingham, had been subjected to “hospital treatment,” and admitted that this euphemism meant administering food by force. The process employed was the insertion of a tube down the throat into the stomach and pumping the food down. To do this, I am advised, a gag has to be used to keep the mouth open.

That there is difference of opinion concerning the horrible brutality of this proceeding! Women worn and weak by hunger, are seized upon, held down by brute force, gagged, a tube inserted down the throat, and food poured or pumped into the stomach. Let British men think over the spectacle.

In 1913 the British Government sought a better way to treat such prisoners. The Prisoner’s (Temporary Discharge of Ill Health) Act came into force.
Suffragettes were now allowed to go on hunger strike, but as soon as they became ill they were released. Once the women had recovered, the police rearrested them and returned them to prison where they completed their sentences. This successful means of dealing with hunger strikes became known as the Cat and Mouse Act.

Now step forward in time to the 1970s and ’80s. Prisoners detained for terrorism in Northern Ireland undertook hunger strikes in support of demands that were unacceptable to British public opinion. In words so terribly familiar today, the Cat and Mouse Act could not be employed, on the grounds that alleged IRA gunmen could not be let loose on the streets. At the same time, the British government could not countenance creating martyrs by letting them die.

Debate on force-feeding came to a head in the UK in the 1970s when two Irish prisoners, Dolours and Marian Price, legally challenged the Home Office’s right to force-feed in any case other than where refusal of food arose from a medical or psychiatric condition. It caused a furor, and the prison policy of involuntary feeding that earlier IRA prisoners had experienced was overturned.

In 1981 the wishes of hunger strikers were respected and doctors supervised death-fasts in Northern Ireland. The death of Bobby Sands came as a result. The policy was subsequently refined, so that when prisoners became too weak to communicate effectively, the prisoner’s priest met with family members so that a final decision on intervention could be taken.

The hunger strikes came to an end, in part because of the realization that each of the families of the strikers would ask for medical intervention whenever the strikers lapsed into unconsciousness. At the same time, on 6 October 1981 James Prior, then Secretary of State for Northern Ireland, announced a series of measures that went a long way toward meeting many aspects of the prisoners’ five demands.

The relevance of this history to Guantánamo Bay will become clear.

The New York Times of February 9, 2006, includes this information:

United States military authorities have taken tougher measures to force-feed detainees engaged in hunger strikes at Guantánamo Bay, Cuba, after concluding that some were determined to commit suicide to protest their indefinite confinement, military officials have said.

In recent weeks, the officials said, guards have begun strapping recalcitrant detainees into “restraint chairs,” sometimes for hours a day, to feed them through tubes and prevent them from deliberately vomiting afterward.
Some officials said the new actions reflected concern at Guantánamo and the Pentagon that the protests were becoming difficult to control and that the death of one or more prisoners could intensify international criticism of the detention center.

Colonel Martin said force-feeding was carried out “in a humane and compassionate manner” and only when necessary to keep the prisoners alive. He said in a statement that “a restraint system to aid detainee feeding” was being used but refused to answer questions about the restraint chairs.

The Times quotes lawyers representing six of the prisoners:

“It is clear that the government has ended the hunger strike through the use of force and through the most brutal and inhumane types of treatment,” said Thomas B. Wilner, a lawyer at Shearman & Sterling in Washington, who last week visited the six Kuwaiti detainees he represents. “It is a disgrace.”

The extent of this disgrace is indicated in the article:

The Guantánamo prison, which is holding some 500 detainees, has been beset by periodic hunger strikes almost since it was established in January 2002 to hold foreign terror suspects. At least one detainee who went on a prolonged hunger strike was involuntarily fed through a nasal tube in 2002, military officials said.

Since last year, the protests have intensified, a sign of what defense lawyers say is the growing desperation of the detainees. In a study released yesterday, two of those lawyers said Pentagon documents indicated that the military had determined that only 45 percent of the detainees had committed some hostile act against the United States or its allies and that only 8 percent were fighters for Al Qaeda.

These words are chilling: “‘This is just a reality of long-term detention,’ a Pentagon official said. ‘It doesn’t matter whether you’re at Leavenworth or some other military prison. You are going to have to deal with this kind of thing.’”

We do not know the exact methods adopted to force-feed these prisoners, not least because the Pentagon is reluctant to go into details and some of its statements conflict:

Until yesterday, Guantánamo officials had acknowledged only having forcibly restrained detainees to feed them a handful of times. In those cases, the officials said, doctors had restrained detainees on hospital beds using Velcro straps.

Two military officials, who insisted on anonymity because they were not authorized to discuss the question, said that the use of restraint chairs started after it was found that some hunger strikers were deliberately vomiting in their cells after having been tube-fed and that their health was growing precarious.

In a telephone interview yesterday, the manufacturer of the so-called Emergency Restraint Chair, Tom Hogan, said his small Iowa company shipped five $1,150 chairs to Guantánamo on Dec. 5 and 20 additional chairs on Jan. 10, using a military postal address in Virginia. Mr. Hogan said the chairs were typically used in jails, prisons and psychiatric hospitals to deal with violent inmates or patients.

In the absence of more information, our sources can only be those quoted in The Times:

...a Kuwaiti detainee, Fawzi al-Odah, told [his lawyer] last week that around Dec. 20, guards began taking away items like shoes, towels and blankets from the hunger strikers.

Mr. Odah also said that lozenges that had been distributed to soothe the hunger strikers’ throats had disappeared and that the liquid formula they were given was mixed with other ingredients to cause diarrhea, Mr. Wilner said.

On Jan. 9, Mr. Odah told his lawyers, an officer read him what he described as an order from the Guantánamo commander, Brig. Gen. Jay W. Hood of the Army, saying hunger strikers who refused to drink their liquid formula voluntarily would be strapped into metal chairs and tube-fed.

Mr. Odah said he heard “screams of pain” from a hunger striker in the next cell as a thick tube was inserted into his nose. At the other detainee’s urging, Mr. Odah told his lawyers that he planned to end his hunger strike the next day.
This description echoes the words of one of those IRA prisoners in Northern Ireland, before the British government was made to face its inhumanity in 1981. Sinn Féin’s Gerry Kelly, in an interview with the North Belfast News in 2004, said:

“They press their knuckles into your jaws and press in hard. The way they finally did force feed me was getting forceps and running them up and down my gums,” he said.

“I opened my mouth, but I was able to resist after that,” said the Sinn Féin man in the interview.

“Then they tried - there’s a part of your nose, like a membrane and it’s very tender - and they started on that. It’s hard to describe the pain. It’s like someone pushing a knitting needle into the side of your eye. As soon as I opened my mouth they put in this wooden bit with a hole in the middle for the tube. They rammed it between my teeth and then tied it with cord around my head.

“Then they got paraffin and forced it down the tube. The danger is that every time it happens you think you’re going to die. The only things that move are your eyes.

“They get a funnel and put the stuff down.”

The New York Times quotes a government official:

“There is a moral question,” the assistant secretary of defense for health affairs, Dr. William Winkenwerder Jr., said in an interview. “Do you allow a person to commit suicide? Or do you take steps to protect their health and preserve their life?”

There is indeed a moral question - one that the international community has answered, and it reaches very different conclusions from those apparently reached by the United States.

The World Medical Association, which includes support from the British Medical Association, has deemed the involuntary feeding of hunger strikers as coercive and provides an alternative route. Its statement, adopted by the 43rd World Medical Assembly in Malta in November 1991 and editorially revised at the 44th World Medical Assembly at Marbella, Spain, in September 1992 can be read here.

The preamble is below:

The doctor treating hunger strikers is faced with the following conflicting values:

There is a moral obligation on every human being to respect the sanctity of life. This is especially evident in the case of a doctor, who exercises his skills to save life and also acts in the best interests of his patients (Beneficence).

It is the duty of the doctor to respect the autonomy which the patient has over his person. A doctor requires informed consent from his patients before applying any of his skills to assist them, unless emergency circumstances have arisen in which case the doctor has to act in what is perceived to be the patient’s best interests.

This conflict is apparent where a hunger striker who has issued clear instructions not to be resuscitated lapses into a coma and is about to die. Moral obligation urges the doctor to resuscitate the patient even though it is against the patient’s wishes. On the other hand, duty urges the doctor to respect the autonomy of the patient.

Ruling in favour of intervention may undermine the autonomy which the patient has over himself.

Ruling in favour of non-intervention may result in a doctor having to face the tragedy of an avoidable death.

A doctor/patient relationship is said to be in existence whenever a doctor is duty bound, by virtue of his obligation to the patient, to apply his skills to any person, be it in the form of advice or treatment.

This relationship can exist in spite of the fact that the patient might not consent to certain forms of treatment or intervention.

Once the doctor agrees to attend to a hunger striker, that person becomes the doctor’s patient. This has all the implication and responsibilities inherent in the doctor/patient relationship, including consent and confidentiality.

The ultimate decision on intervention or non-intervention should be left with the individual doctor without the intervention of third parties whose primary interest is not the patient’s welfare. However, the doctor should clearly state to the patient whether or not he is able to accept the patient’s decision to refuse treatment or, in case of coma, artificial feeding, thereby risking death. If the doctor cannot accept the patient’s decision to refuse such aid, the patient would then be entitled to be attended by another physician.
The excellent New York Times report came and went with little remark in the mainstream press. The treatment of prisoners on hunger strike by forcible feeding continues.

“Saving” prisoners from their hunger strike is a deceptive distortion of a cruel and unacceptable coercion that needs our urgent attention to bring to an immediate end. If we dare not allow prisoners to seek death as a means of escaping their circumstance or because they want to make martyrs of themselves, and yet we cannot meet any of their demands for the promise of a fair trial or some relief from their seemingly endless imprisonment, why cannot we follow the procedures demanded by the World Medical Association? If this is not acceptable, why cannot we adopt the British measures in Northern Ireland, which respected prisoners’ wishes until the point when imams and families can be involved in the decision-making regarding medical intervention?
Our answer at the moment is to revert to a practice that was discredited as cruel and barbaric a hundred years ago.

Please show the mercy to these people that seems absent in our lawmakers and bring this issue to the attention of Congress through your representatives. I shall be doing so in the United Kingdom. Perhaps our Canadian and European friends can also raise questions on this treatment of detainees with representatives of their own government to increase international pressure.
Note: I do not want to reawaken the deep hurt of such recent events that is still keenly felt on both sides of the Atlantic. The deaths of Bobby Sands and his nine colleagues were some of the many, many tragic consequences of the troubles. I pay my respect to him and his dedication to his convictions now, although I cannot accept his support of violence in response to the wrongdoings he saw as being perpetrated by the British government.

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