Nourishing torture: medicine, security and joint operations

I try to refrain from writing ‘look at what I read over breakfast this morning’ posts, but I must make an exception for the video I watched over my unusually bleak bowl of porridge this morning. A warning to readers that the warning accompanying the video, ‘some viewers may find these images distressing’, understates the content therein.

Reprieve’s latest video shows the force feeding of US actor and rapper Yasiin Bey (formerly known as Mos Def).  There are currently 120 detainees on strike in Guantanamo and 42 of them are being fed against their will. According to Reprive the video accurately represents the standard operating procedure of US force-feeding methods. We have every reason to believe the video is a factually fair representation because it is based on, and corroborates, the official force feeding SOP’s which were made made public earlier this year in a document leaked from SOCOM to Al Jazeera. The 33 page document (available here), entitled ‘medical management of detainees on hunger strike’ was issued in March 2013 by the Joint Task Force  -GTMO – Joint Medical Group. If you’re wondering who that is (I was wondering the same this morning), I’m not sure the following excerpt gets us very far, but it does speak to another point I’d like to make:


President Obama has expressed his public support for force feeding because he doesn’t want to see anybody die. This refrain is in fact the key ethical and legal justification for force feeding: the state and the prison service are required to provide medical treatment to those requiring it. Life must live even if it doesn’t want to, or some life anyway. We know too that he cares deeply for the nations health; hence Obamacare. The unfortunate thing, or rather one of the unfortunate things about the moment of intervention in Guantanamo in is that the power to decide when and who will be force fed is that of the Guantanamo Commander Rear Admiral John Smith and not, as one might reasonably expect, the medical staff. (Its a cheap shot, I know, but this does sound strangely like the direction of the NHS under the Conservative British Government — see here for a hint of what I mean). But gastroenterological interventions in Guantanamo are not simply sovereign decisions but are carefully articulated bio-political ones which require, in the words of the manual, a

“close partnership between the JMG [joint medical group] medical staff and the Joint Detention Group (JDG) security force”

The SOP manual sets forth its criteria for calibrating who ‘qualifies’ for care. Prisoners are designated as hunger strikers  if they communicate,

“either directly or indirectly (ie: repeated meal refusals) his intent to undergo a hunger strike or fast as a form of protest or demand attention. A detainee may [also] be designated a hunger striker  after  missing nine consecutive meals or weight loss to a level less than 85% Ideal Body Weight (IBW). The designation of a detainee is based on intent, purpose and behaviour […] In general, lack of sufficient daily caloric intake is a more useful measure to designate a hunger striker  than the number of consecutive meals missed”

As regards the actual procedure, I think I need not say more if you have already watched the above but the document does require a careful examination, one I can’t provide in any detail here. Suffice it to say that the producers are medically meticulous and seeming all eventualities have been planned and prepared for. If the striker bites his (the document only uses the male pronoun) tube, there is a procedure to follow; the tube is taken out, inspected and re-inserted. You get the impression, and if you don’t, please do refer to the ‘general algorithm for a hunger strike’ enclosed in the report.

Screen Shot 2013-07-12 at 11.34.41 AMTHE VIDEO isn’t so much a reenactment because half way through the procedure it becomes clear that nobody, neither Bey or the medical staff are acting. Bey is strapped down while a feeding tube is shoved up his nose, down his esophagus and into his stomach. He resists, clearly in severe discomfort and when he can take no more he calls for it to stop. The affective dimension of the video is overwhelming and needless to say it is squarely aimed at eliciting an emotive reaction. The video last 4 minutes, but according to Reprive (whose lawyers regularly visit detainees) the full procedure lasts upto 2 hours and is performed twice per day.

Hunger strikes have a long history as a political tactic of resistance, be it Ghandi’s protest of British colonial rule, the Suffragettes struggle for voting rights a the turn of the 20th Century or the Irish Republican strike against British imprisonment. There’s scope for a fascinating study which ties these histories together, especially because the existing literature seems to focus on specific major hunger strikes. Karin Fierke is the exception here, and her book, Political Self-Sacrifice (which I’ve only had chance to glance over), looks like the place to start. From the blurb, Fierke’s book

“examines a range of different forms of political self-sacrifice, including hunger strikes, self-burning and non-violent martyrdom, all of which have taken place in resistance to foreign interference.”


Palestinian political prisoners and Guantanamo Bay detainees have put hunger strikes on the front pages of major international newspapers, especially over the last decade. The reasons for their strikes vary, but beyond the obvious point that these prisoners are using their body as a weapon  to draw attention to the plight of their situation, the connections between those in Israeli prisons and those Guantanamo are not singular, but neither are they straightforward.

The struggle of Palestinian prisoners made headlines in 2012 when five  detainees waged prolonged hunger strikes in protest of their detention (I have written about some of this here). Ahead of last year’s Palestinian Prisoners’ Day, 1,600 additional Palestinians launched a mass hunger strike as a show of support and solidarity with those already on prolonged strike. The display was repeated earlier this year by 800 prisoners.

It is not yet clear what the Israeli position is on force feeding but in May this year the Health Ministry issued regulations mandating the compulsory hospitalization of those on hunger strike for longer than 28 days. In July 2013, these already forceful measures became more explicit on the question of force feeding when it became known that the Justice Ministry is formulating a draft bill that would make it possible to force-feed hunger-striking prisoners, subject to court approval. All of this makes sense if we accept the obligation to keep alive those who have elected to refrain from that which keeps them alive, but we know that this isn’t the only or even primary reason why Israel and the U.S. pursues such medical intervention with such vehemence. Hunger strikes would seem to be working, if by ‘working’ we can take to mean that Israel has given in to some demands to shorten sentences and free some prisoners. Samer Issawi is a case in point, though many have not been so ‘lucky’.

Samer Issawi ended his hunger strike in April 2013 after 256 days. Source: Haaretz
Samer Issawi ended his hunger strike in April 2013 after 256 days. Source: Haaretz

But for other types of medical violations we must look beyond force feeding, and for such examples in the Israeli context the Physicians for Human Rights report provides what they call a ‘laundry list’ of violations conducted by the Israeli Prison Service. In summary PHR write:

“The report suggests that the ways in which the IPS medical system dealt and handled the cases of hunger strikers over the past year, underlines the high extent to which the prison medical system is amenable to the prison system, which is in turn amenable and subordinate to Israel’s political echelons. Information gathered over the course of the year also raises concerns that on account of this subordination, the prison medical system in fact operates according to political and security considerations, rather than medical considerations, the former of which runs contrary to the interests of the hunger striking patient. Furthermore, they worsen situations of dual loyalty (in which physicians have responsibility to the patient on one hand, and to their employer on the other), a problem already rampant among medical practitioners employed by the IPS.”

Both Guantanamo and the IPS archipelago apparently suffer from the same blurring of the lines between security , military and medicine. Whether medical staff are complicit in such blurring depends on what responsibility we ascribe to them, but in the same way that we have witnessed the coming together of certain humanitarians and militaries (a la Eyal Weizman) perhaps we’re also witnessing some explicitly medical inflections of what Costas Douzinas once called ‘military humanism’. Perhaps the best example of  critical work done at the intersection of war and medicine is that of Omar el Dewachi and his forthcoming book, The Ungovernable: Warfare and Mandatory Medicine in Iraq. Omar and I have had brief conversations about what he calls therapeutic geographies, and I wonder how these stories of nourishing torture fit into and reconfigure these geographies.

In other news, members from the Israeli Medical Association have been invited to the U.S. to present policy makers there with their methods of handling hunger strikers. Only one question remains then: I wonder if Dov Weizglass is a member? For those who don’t know who Weizglass is, I remember him as a chief architect of the blockade on Gaza who explained the rational for limiting the caloric count of 3.5 million Palestinians thus: “The idea,” he said, “is to put the Palestinians on a diet, but not to make them die of hunger.” At least Guantanamo staff are observing the rules of Ramadan and are only conducting force-feeding during the night. Or is that to miss the point about the compassionate carceral hand that feeds them?

One Comment

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  1. Horrifying – thanks for sharing Jones.

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