by Stephen Lendman

Guantanamo detention constitutes torture, abuse and ill-treatment. Long-term detention compounds it.

Force-feeding increases unconscionable pain and suffering. Doing so violates core rule of law principles

Around 130 of 166 Guantanamo detainees refuse food. They're hunger striking for justice. They began in February. They passed 100 days. They'd rather die than endure injustice. Their only escape route is death.

Pentagon officials at first maintained silence. Belatedly they admitted what's well-known. They consistently downplayed it. Now they admit 102 detainees refuse food. At least 130 are involved. Obama dismissively said nothing. His belated acknowledgement reflected disdain for their pain and suffering.

Thirty or more hunger strikers are being force-fed. Doing so constitutes torture. A previous article explained.

Detainees are restrained in chairs. They're called "padded cells on wheels."

Tubes are forced painfully through their noses and throats to their stomachs. It's done abrasively. It draws blood.

Liquid nutrients are pumped into their stomachs. Doing so causes excruciating pain. No sedatives or anesthesia are given. Men are kept strapped under restraints up to two hours.

It's done to prevent purging. The procedure's repeated twice daily. Tubes are reused. They're covered in blood and stomach bile.

Reportedly they're passed from one inmate to another. Proper sanitation is non-existent. One detainee called the procedure "torture, torture, torture."

Those refusing force-feeding are brutally beaten. Injuries occur. Hospitalization at times follows.

The World Medical Association says force-feeding violates fundamental medical ethics. When accompanied by "threats, coercion, force, and use of physical restraints, (it's) considered inhuman and degrading treatment."

Al Jazeera obtained a 30 page Pentagon document. It's dated March 5, 2013. It's titled "Standard Operating Procedure (SOP): Medical Management of Detainees on Hunger Strike."

It explains updated force-feeding methods. Medical personnel are involved. Doing so violates core ethical standards and guidelines.

Strikers are shackled in restraint chairs. They're held up to two hours. Masks cover their mouths. Tubes 61cm or longer snake through their nose and throat to their stomachs.

The procedure continues until a chest x-ray or test dose of water confirms it's properly in place. The process is excruciatingly painful.

When feeding ends, detainees are placed in "dry cells." No running water's permitted. Guards observe them up to an hour. They do so "for any indications of vomiting or attempts to induce vomiting."

If it occurs, the detainee's returned to a restraint chair. The process repeats. The updated SOP replaces 2003 policy. In 2005, it was revised. With redactions, it was declassified.

On March 5, the new unredacted policy took effect. It was one month after hunger striking began. It was implemented to handle mass striking.

According to the Pentagon's document:

"Just as battlefield tactics must change throughout the course of a conflict, the medical responses to GTMO detainees who hunger strike has evolved with time."

"A mass hunger strike was successfully dealt with in (2005) by utilizing procedures adopted from the Federal Bureau of Prisons and the approach delineated in this SOP."

"However, the composition of the detainee population, camp infrastructure, and policies has all undergone significant change since the initial version of this SOP."

"Much of the original instruction has been retained in the form of enclosures. In the event of a mass hunger strike, these enclosures can be utilized as they have proven efficacy under mass hunger strike conditions."

"(I)n the event of a mass hunger strike, isolating hunger striking patients from each other is vital to prevent them from achieving solidarity."

On April 13, guards implemented a pre-dawn raid. Over 100 prisoners were isolated. Doing so tried to break their morale. It didn't work.

Leonard Rubenstein's a human rights and medical ethics advocate lawyer. He's a Johns Hopkins Bloomberg School for Public Health visiting scholar. He serves at its Center for Public Health and Human Rights and Center for a Livable Future.

He reviewed the Pentagon document. He called it troubling. It prohibits medical professionals from acting responsibly. They're "adjuncts of the security apparatus."

It's "very frightening," he said. "The clinical judgment of a doctor or a nurse is basically trumped by this policy and protocol."

"Doctors are not acting with (ethical) professional medical independence. It's clear that, notwithstanding references to preservation of detainee health in the policy, the first interest is in ending the protests."

Detainee needs and welfare aren't addressed. Ways to treat mental health problems are ignored.

Guantanamo's commander alone decides who's force-fed. Medical personnel have no say. They're told to follow orders.

According to the document:

"In the event a detainee refrains from eating or drinking to the point where it is determined by the medical assessment that continued fasting will result in a threat to life or seriously jeopardize health, and involuntary feeding is required, no direct action will be taken without the knowledge and written approval of the Commander."

With or without consent, "medical procedures that are indicated to preserve health and life shall be implemented…"

According to the Constitution Project's Task Force on Detainee Treatment:

"(A)t least some federal prisons handle hunger strikes very differently, and far less coercively, than at Guantanamo."

"The written federal guidelines for force-feeding make no mention of restraints, and include several safeguards that are not in place in Guantanamo."

"Prison guidelines require the warden to notify a sentencing judge of involuntary feeding, with an explanation of the background of and reasons for involuntary feeding, as well as videotaping of force-feeding."

"BOP requires that 'treatment is to be given in accordance with accepted medical practice.' "

It "requires an individualized assessment of the patient's situation that appears to be absent at Guantanamo. It also requires individualized counseling of the detainee…"

"(T)he BOP's written policy on the use of restraints also conflicts with the restraint-chair protocol at Guantanamo."

"Federal prisons are known to use restraint chairs for inmates who are physically dangerous to themselves, other inmates, or guards - but at most federal prisons, the chairs are apparently not used for forced feeding."

At times, several attempts are needed to assure correct force-feeding tube placement. Once down a detainee's throat, breathing difficulties may occur.

Prisoners get a choice at mealtime. "Eat a hot meal, drink the nutrient, or receive an enteral feed."

On May 4, The Lancet headlined "Guantanamo: hunger strikes and a doctor's duty," saying:

" 'It can't go on like this' is a common response to a desperate situation: yet too often it can, and it does."

"Military doctors asked to force-feed individuals on hunger strike will experience divided loyalties."

"The demands of the state may clash with the politically neutral opinion of the international medical community."

"(F)orce-feed(ing) infringes the principle of patient autonomy." Standards of humanity and dignity are violated.

On April 24, American Medical Association (AMA) president Jeremy Lazarus wrote Defense Secretary Chuck Hagel.

He stated AMA's longstanding position. Physician participation in force-feeding violates core medical professional ethics.

"Every competent patient has the right to refuse medical intervention, including life-sustaining interventions," he stressed.

"We urge you to ensure that this matter receives prompt and thorough attention and to address any situation in which a physician may be asked to violate the ethical standards of his or her profession."

Physicians for Human Rights senior medical advisor Vincent Iacopino has extensive knowledge of Guantanamo detainees' abuse. He examined them. He testified in court on their behalf.

"Hunger strikes shouldn't be confused with the intent to commit suicide," he said. "Hunger strikes are a form of protest, an attempt to shame detainee authorities into action by individuals who are desperate to have some control over their lives."

Confrontational responses fuel protests, he added. "There's no therapeutic relationships between (detainees) and medical personnel and doctors." Mitigating hunger strikes requires having a clinician who will respect your autonomy. That doesn't exist at Guantanamo."

The Center for Constitutional Rights applauded the AMA's condemnation. In response, Executive Director Vincent Warren said:

"In reaffirming its long-standing opposition to force feeding Guantanamo prisoners, the country’s most prominent medical association has delivered a stinging rebuke to the Obama administration’s wholly inadequate response to the hunger strike."

"The AMA’s condemnation comes on the heels of reports that the Department of Defense has ordered additional military doctors to report to Guantanamo to deal with the hunger strike - presumably to facilitate a practice that the AMA considers contrary to established medical ethical standards."

"The administration cannot force feed its way out of this growing medical emergency. The only true solution is to resume transfers of prisoners and close Guantanamo."

Uncharged detainees should be freed. They should have been long ago. They never should have been detained and tortured in the first place.

Appalling abuses continue. Doing so violates core international, constitutional, and US statute provisions. Obama bears full responsibility.

The ACLU condemned force-feeding. It called doing so "a brutal, degrading experience."

"Of course, the military should be doing far more than ending cruel, inhuman, and degrading force-feeding and any abuse of the men."

"It should be working diligently and urgently to release Guantanamo prisoners, starting with the 86 men already long cleared to leave the prison. The ACLU will continue to press on all these matters until the rule of law is restored and ill-treatment in Guantanamo ends."

On May 13, 19 organizations wrote Chuck Hagel. They included:

The ACLU

Asylum and Human Rights Program, Boston University School of Law

Bill of Rights Defense Committee

Center for Constitutional Rights

Center on National Security at Fordham Law

Coalition for an Ethical Psychology

Council on American-Islamic Relations

Defending Dissent Foundation

Global Justice Clinic, NYU School of Law

Human Rights Watch

Human Rights First

International Justice Network

Ludwig Boltzmann Institute for Human Rights

Physicians for Human Rights

Psychologists for Social Responsibility

Reprieve

The Center for Victims of Torture

Washington State Religious Campaign Against Torture

Witness Against Torture

The letter states:

"We write to request that you intervene to end the force-feeding of competent hunger-striking prisoners in Guantanamo Bay, which constitutes cruel, inhuman, and degrading treatment."

"We also urge you to investigate and address recent allegations of the use of excessive force, isolation, temperature manipulation, and forced sleeplessness in Guantanamo, which could also constitute cruel, inhuman, and degrading treatment, and which raise even greater concerns if applied in combination with force-feeding."

"At least 100 of the 166 men currently held at Guantanamo are on hunger strike, including many who have long been approved for release from the prison."

"By all accounts, the root cause of the hunger strike is the prisoners’ belief that they will be indefinitely imprisoned and likely die in Guantanamo. At the most recent count, 29 of the men are being force-fed."

"The force-feeding process is inherently cruel, inhuman, and degrading. The prisoner is strapped into a chair with restraints on his legs, arms, body, and sometimes head, immobilizing him."

"A tube is inserted up his nostril, and snaked down his throat into his stomach. A liquid nutritional supplement is then forced down the tube. The prisoner is restrained in the chair for upwards of two hours to prevent him from vomiting."

"As Guantanamo hunger-striker Samir Naji al Hasan Moqbel explained recently: 'I can’t describe how painful it is to be force-fed this way. As it was thrust in, it made me feel like throwing up. I wanted to vomit, but I couldn’t. There was agony in my chest, throat and stomach. I had never experienced such pain before.' "

"Debilitating risks of force-feeding include major infections, pneumonia, collapsed lungs, heart failure, post-traumatic stress disorder and other psychological trauma."

Because of force-feeding’s invasive nature, the World Medical Association (WMA), the preeminent international organization in the field of medical ethics and practice, has repeatedly condemned force-feeding of competent prisoners."

"The WMA’s Tokyo Declaration, adopted in 1975, states that doctors shall respect a competent prisoner’s right to refuse artificial feeding."

"And, in its Declaration of Malta on Hunger Strikers, adopted in 1991 and revised in 2006 in large part due to developments in Guantanamo, the WMA states that '(f)orcible feeding is never ethically acceptable.' "

" 'Even if intended to benefit, feeding accompanied by threats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment.' "

"The American Medical Association, a member of the WMA, has endorsed these unequivocal principles, as evidenced by its April 25, 2013 letter to you."

"The International Committee of the Red Cross has similarly stated: 'The ICRC is opposed to forced feeding or forced treatment; it is essential that the detainees’ choices be respected and their human dignity preserved.' "

"Force-feeding as used in Guantanamo violates Common Article 3 of the four Geneva Conventions of 1949, which bar cruel, humiliating and degrading treatment."

"It also could violate the Detainee Treatment Act of 2005, which prohibits the 'cruel, inhuman, or degrading treatment' of prisoners 'regardless of nationality or physical location.' "

"Indeed, a 2006 joint report submitted by five independent human rights experts of the United Nations Human Rights Council (formerly the UN Commission on Human Rights) found that the method of force-feeding then used in Guantanamo, and which appears to remain in effect today, amounted to torture as defined in Article 1 of the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, which the United States ratified in 1994."

"The report also asserted that doctors and other health professionals authorizing and participating in force-feeding prisoners were violating the right to health and other human rights, including those guaranteed by the International Covenant on Civil and Political Rights, which the United States ratified in 1992."

"Those concerns were reiterated this month by the Office of the UN High Commissioner for Human Rights, the Inter-American Commission on Human Rights, the United Nations Working Group on Arbitrary Detention, and three UN Special Rapporteurs."

"In light of the above, we urgently request that you order the immediate and permanent cessation of all force-feeding of Guantanamo prisoners who are competent and capable of forming a rational judgment as to the consequences of refusing food."

"We request that you allow independent medical professionals to review and monitor the status of hunger-striking prisoners in a manner consistent with international ethical standards. We also request that you investigate and rectify any abusive conditions and treatment in addition to force-feeding."

Obama promised to close Guantanamo. He's done nothing to do so. No closure plan exists. Detainees are held indefinitely. Most or perhaps all committed no crimes.

They're lawlessly held. Their only escape route is death. Obama bears full responsibility. He's unaccountable. He's guilty of multiple crimes of war and against humanity. Justice remains denied.

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Stephen Lendman lives in Chicago and can be reached at lendmanstephen@sbcglobal.net.

His new book is titled "Banker Occupation: Waging Financial War on Humanity"

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Visit his blog site at sjlendman.blogspot.com

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