Majdi Mohammed / AP Photo

Force-feeding Palestinian prisoners pits Israeli doctors against lawmakers

New law requiring physicians to force-feed hunger striking inmates shunned by medical community as torture

The rapidly deteriorating health of a Palestinian political prisoner on hunger strike has pit Israeli legislators, who recently enacted a law mandating that he be force-fed, against physicians, who refuse to comply on grounds that doing so would be unethical and tantamount to "torture."

Mohammed Allaan, 30, a West Bank lawyer accused of working with the armed group Islamic Jihad, has refused food, vitamins, supplements and even medical treatment for almost 60 days in protest of his detainment.

Allaan was arrested in November 2014 and has since been held in administrative detention — a controversial form of imprisonment that allows Israeli authorities to detain individuals indefinitely without charge, trial or access to counsel if they are deemed a security threat.

Since Israel’s occupation of Palestinian territories in 1967, its military has placed thousands of Palestinians in administrative detention. At the end of June 2015, there were 370 Palestinians in Israeli prisons classified as such, according to Israeli human rights group B’Tselem.

For Palestinians who find themselves in Israeli prisons, hunger strikes have become a common way of drawing public attention to their plight and challenging their treatment or detainment — sometimes with success.

On Aug. 9, some 180 Palestinian prisoners ended a coordinated hunger strike after just one day, claiming their demands were met. Israeli prison authorities made concessions over search procedures, and agreed to return dozens of Palestinian prisoners back to a a wing of Nafha Prison where they were previously held, Palestinian Prisoners Society chairman Qadura Fares told Haaretz

In July, Palestinian political prisoner Khader Adnan, who was also held in administrative detention for alleged ties to Islamic Jihad, was freed after his 54-day hunger strike ignited protests across the Palestinian territories and garnered international attention, including pressure from various human rights groups.

Adnan and Allaan's form of hunger strike differs from tactics employed by most other Palestinian prisoners, according to Tamar Karni, the chairwoman of the Israeli Medical Association’s (IMA) ethics committee. “All the administrative detainees, except Khader Adnan, agreed to accept saline intravenous infusion with vitamin injections to prolong their life,” Karni said. “Similarly to Adnan, Allaan has refused to accept this palliative care.”

To keep hunger strikers alive and avoid potential public unrest, Israel’s parliament, the Knesset, passed the controversial “Law to Prevent Harm Caused by Hunger Strikers” on July 30, granting authorities the legal right to force-feed prisoners on hunger strike when their lives are in danger. 

Members of the IMA, however, have refused to comply, saying that doing so would be a breach of their Hippocratic Oath.

“Forced-feeding is equivalent to torture and every physician has the right to refuse to force-feed a hunger striker against his or her will,” the IMA states in its Physician’s Guide to Treating the Detainee/ Prisoner on a Hunger Strike.

IMA chairman Leonid Eidelman said, "Anyone who has seen how [force-feeding] is performed on one who is conscious and one who is opposed to and fighting it" will agree it’s “torture.” 

According to Eidelman, there are only two circumstances in which Allaan should receive medical treatment: “if Allaan gives up his hunger strike and allows it or if he loses consciousness.”

"Doctors are ready to resuscitate him if he loses conscience" but will not intervene otherwise, he added.

Guantánamo example

Israel has yet to implement its hunger strike law, but testimony from inmates held in U.S. custody at Guantánamo Bay, Cuba, who’ve been force-fed by prison officials illustrates why the procedure is so controversial.

U.S. guards force-fed detainees after they launched two prisonwide hunger strikes – in 2005 and 2013 — to protest their indefinite detainment, ill treatment and the suspicious deaths of fellow inmates. Prisoners have also launched a number of individual hunger strikes since the Pentagon began remanding alleged “terrorists” to the facility in 2002, and have also been force-fed.

Emad Hassan, a Yemeni national who has been imprisoned at Guantánamo since June 2002 and began his hunger strike in 2007, was force-fed through nasal tubes more than 5,000 times. The procedure has left one of his nostrils fully closed and the other partially damaged.

Ahmed Rabbani, a Pakistani national detained at Guantánamo for more than 10 years, began vomiting blood after feeding tubes were improperly forced inside his nose, the Guardian reported.

Sami al-Hajj, a Sudanese national and Al Jazeera journalist who was held at the military prison for more than six years, has describe being restrained as prison guards shoved feeding tubes down his nose. “You see the blood and everything inside” the tube, Hajj said on Democracy Now, describing how guards would not clean the tubes after they were used on previous inmates. 

Based on these testimonies and others, opponents of force-feeding have dismissed arguments by supporters that the practice is necessary to protect the health of striking inmates. In fact, medical professionals have gone so far as to call it deadly.

In 2013, American Medical Association then-President Jeremy Lazarus sent a letter to then–Defense Secretary Chuck Hagel stating, “Force feeding of detainees violates core ethical values of the medical profession.”

The U.S. government has withheld medical information about its use of force-feeding, but Israeli physicians are well aware of the health risks associated with the practice.

According to Physicians for Human Rights – Israel (PHR), force-feeding methods "carry immediate risks of mechanical damage to surrounding tissues — the nasal tissue, throat, esophagus, lungs, tissues in proximity to veins or different layers of the abdominal wall."

"From 1970 to 1992, there were four prisoners on hunger strike who died after being forced fed, and one other case where a prisoner died after we believe he was force fed, Amany Dayif, PHR's director of the prisoners and detainees department, told Al Jazeera. The state, however, never officially attributed the causes of deaths in any of the cases directly to force-feeding.

In 1996, Israel's Patient's Rights Act established a set of laws for patients, including prisoners. The law states, "No medical care shall be given unless and until the patient has given his informed consent to it." In the case that a patient becomes unconscious, the law requires that there must be "reasonable grounds to suppose that, after receiving treatment, the patient will give his retroactive consent."

The law, passed last month, "contradicts [the act] totally," said Dayif, adding that the new law allows the "judge to make the decision, not the doctors, based on political circumstances instead of the health or rights of the patient."

Karni, chairwoman of the IMA’s ethics committee, recently visited Allaan at Soroka Medical Center in Be'er Sheva, where he was being monitored by physicians, and unsuccessfully tried to convince him to accept palliative care, Al-Monitor reported.

“This is his legitimate and nonviolent way of protesting and we shouldn’t act against his wish — or else it falls under the category of torture,” she said.

Physicians fear that Allaan’s recent transfer from Soroka Medical Center, where doctors opposed feeding him against his will, to Barzilai Medical Center in Ashkelon, may be an attempt to find doctors who are willing to comply with the new law.

Eidelman, however, said that efforts to prolong Allaan’s life through force-feeding would not work "because in his situation, we cannot correct all the abnormalities in his body because of his prolonged fasting."

Improving Allaan's health would require doctors to treat him slowly for weeks. "In this situation it cannot be done forcibly," Eidelman said.

Tensions rising

Allaan's prolonged detention has already led to protests, his force-feeding could spark further unrest.

Dozens of Palestinians in East Jerusalem launched an open sit-in at the International Committee of the Red Cross on Monday that will last until Israel ends its administrative detention of Allaan, activist Muhammad al-Shalabi told Ma’an news. If Allaan is force-fed or dies, protests could erupt throughout the Palestinian territories, especially since tensions are already high after a suspected Israeli settlers firebombed a house in the West Bank, killing a toddler and his father, and severely burning other family members. 

About 100 Palestinian citizens of Israel carried out a demonstration outside the Barzilai Medical Center where Allaan is being held, Haaretz reported. They are demanding Allaan's release from administrative detention. A group of about 50 Israeli Jews, launching a counter protest, threw stones, bottles and eggs at the Arab protesters after the Palestinian flag was raised in front of the hospital. 

A United Nations joint statement directly addressing Israel’s new hunger strike law echoed concern over such practices. “The principle of an individual’s right to informed and voluntary refusal of medical measures is reiterated in several basic United Nations human rights documents where lack of free and informed consent is considered a clear violation of an individual’s right to health,” it said.

According to the 1975 Declaration of Tokyo, which medical associations around the world adhere to, "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." 

In September, Israel’s Supreme Court is scheduled to hear a petition filed by the IMA, arguing that force-feeding is a violation of the law.

Adalah, legal center for Arab rights in Israel, has also vowed to launch constitutional challenges if Allaan is forced-fed.

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