Introduction
Around the world, the principle of medical neutrality – that doctors first and foremost have duties to their patients in accordance with medical ethics and without interference, is under attack. For decades, Physicians for Human Rights (PHR) has documented how health professionals in a range of situations face pressure from powerful authorities to violate professional ethics by using their skills to harm, rather than heal. The use of doctors and other medical personnel to force-feed prisoners on hunger strike is a key example. As the article below, by guest bloggers Dana Moss and Amany Dayif makes clear, the international medical community considers the force-feeding of competent individuals to be unethical, and international law establishes that it is a form of cruel, inhuman, or degrading treatment, and sometimes amounts to torture.
At PHR, we have advocated for the U.S. government to end its policy of force-feeding detainees at Guantánamo Bay, and to stop using health professionals to carry out this form of punishment masquerading as medicine. We’ve also worked to protect the obligation of health professionals to refuse to take part in any form of torture or ill-treatment. Yet the policy of force-feeding to break hunger strikes not only persists at Guantánamo; it has been used to justify force-feeding in other countries, such as Israel.
Our friends at PHR-Israel, which is an independent organization that collaborates as an ally with us in the Safeguarding Health in Conflict Coalition, similarly oppose the Israeli government’s recent policies authorizing force-feeding of hunger strikers who, like the Guantánamo detainees, have taken up this form of non-violent protest as a desperate measure to press for an end to indefinite detention without charge and other abuses. We join our colleagues in supporting their message below and reiterate: force-feeding is a form of ill-treatment, in some cases rising to torture, and health professionals must not take part.
-Susannah Sirkin, Director of International Policy and Partnerships
The news that three Palestinian hunger strikers – one of them on the verge of death – have recently secured an end to administrative detention in Israeli prisons is welcome. Twenty-year-old Malik al-Qaadi and two brothers, Muhammed and Mahmoud al Balboul, had all been refusing food since July, and al-Qaadi was in an induced coma when a deal was struck with Israeli authorities for their release.
But Israel’s ongoing unethical treatment of Palestinian detainees on hunger strike – by now an established pattern – should alarm domestic and international observers alike. The most recent case to hit the courts and headlines involved Bilal Kayed, a 35-year-old man from Nablus who fasted for 71 days to protest his administrative detention. Kayed ended his hunger strike on August 25th, after he reached a deal with the Israeli authorities that his administrative detention would not be renewed. Now, a new landmark decision by Israel’s High Court of Justice (HCJ) essentially renders Israel’s “force-feeding law” legal, to the detriment of detainees like Kayed who have lost one of their only avenues to protest this human rights violation.
Kayed’s case is closed, yet it comes after a long line of similar hunger strikes launched by Palestinian prisoners protesting administrative detention. This system subjects Palestinians to secretive military tribunals and often jail for months and even years without formal charges or a trial. Israeli authorities justify this parallel system that rejects due process by claiming such people are too dangerous to release. This form of detention is a violation of international human rights law.
Until now, each hunger striker has ended his campaign in a last-minute deal with the Israeli authorities, despite prior government pronouncements that the hunger striker had to be held in lengthy administrative detention due to the threat he allegedly posed. In reality, detainees do not take up hunger striking lightly, as it carries the risk of severe medical complications, some of them irreversible. Hunger strikes are a tactic of non-violent resistance by people compelled to risk their health for their freedom. So, as long as the arbitrary and abusive policy of administrative detention continues, so will hunger strikes.
The practice of making last-minute deals with hunger strikers as they approach death is now complicated by the High Court’s decision. The ruling paves the way for the force-feeding of hunger strikers, which deprives detainees of one of the only means they have to drive the Israeli authorities to the negotiating table to end their illegal detention.
The medical community considers force-feeding a form of ill-treatment. The procedure violates international human rights standards as well as domestic and international codes of ethics codes, including the World Medical Association’s Declaration of Malta – which both the Israeli and American Medical Associations have adopted. In fact, the Israeli Medical Association has come out publicly against the new law and the recent High Court of Justice decision.
Israel’s High Court decision comes at a time of increasing pressures on hunger strikers to break their strikes. In Kayed’s case, the Israeli courts showed an increased reluctance to allow an independent doctor to visit or render a medical opinion. While Israeli courts were once more vigilant in terms of ensuring that the Israeli Prison Service grant minimal protection to hunger strikers, they are now less willing to enforce these protections. By depriving hunger strikers of access to an independent medical opinion, the courts are in effect breaking the detainees’ morale and impeding hunger strikes, ultimately suppressing their right to this desperate form of protest.
Kayed’s case mirrors that of journalist Mohammad al-Qeeq, whose situation hit the headlines when he launched his hunger strike early this year in protest of his administrative detention. After a record 94 days, a deal was struck with the Israeli authorities in February 2016 and al-Qeeq’s administrative detention order was not renewed – again, despite earlier claims that his detention was required for security reasons. In reviewing his appeal, the Supreme Court criticized earlier court decisions permitting shackling – a heinous practice designed to humiliate hunger strikers – and questioned the state’s reasoning for continuing this practice.
Similarly, in the case of Khader Adnan, his administrative detention ended after a 56-day hunger strike and a deal struck with the Israeli authorities. Again, this case echoed the pattern by which Israeli authorities claim detainees cannot be released due to security risks, but once they launch a lengthy hunger strike, this determination is withdrawn. Physicians for Human Rights-Israel (PHRI) was able to secure a visit by an independent doctor to evaluate Adnan but was unable to score a legal victory regarding shackling.
Israel’s desire to break the morale of hunger strikers ensures that force-feeding and other abusive practices will continue, in contravention of medical and humanitarian guidelines. The UN Committee Against Torture has stated that Israel must “guarantee that persons deprived of liberty who engage in hunger strikes are never subjected to ill-treatment or punished for engaging in a hunger strike, and are provided with necessary medical care in accordance with their wishes.” Instead, Israel’s latest strategy has helped erode respect for medical ethics and human rights in national and international standards. PHRI and Physicians for Human Rights have been vital medical voices in challenging these practices both in Israel and in the Guantánamo Bay detention center.
Meanwhile, hunger striking will continue as a tool of protest for Palestinian prisoners desperate to challenge Israel’s administrative detention policies. According to the human rights organization Addameer, there are some 700 Palestinians currently held in administrative detention in Israeli prisons, and nearly 100 detainees on hunger strike. They should not have to go to the brink of death in order to secure their rights.