A new report from a task force convened by the Institute on Medicine as a Profession (IMAP) and the Open Society Foundations highlights the role medical professionals have played in breaking political protests among detainees at Guantanamo Bay.

There are more than 160 prisoners at Guantanamo Bay, who remain imprisoned. Only a few detainees have been charged with any crimes. Over 80 prisoners have been cleared for transfer by a presidential review task force established by President Barack Obama.

This year at Guantanamo one of the biggest hunger strikes in the history of the facility took place. Lawyers for detainees reported more than 100 prisoners in the prison were at one point participating in the hunger strike, which aimed to call attention to the inhumanity and hopelessness of their indefinite detention. But the hunger strike, an act of protest, was eventually broken through force-feedings that involved medical personnel.

The Task Force declares in their report titled, “Ethics Abandoned,” which was put together by doctors, “The policy of force-feeding deviates from standard, accepted medical and ethical treatment of hunger strikers and, depending on the individual circumstances, amounts to either torture or inhuman and degrading treatment.” It calls particular attention to the use of a restraint chair, which the facility began to employ in a punitive manner.

“The Task Force is aware of no precedent for using physical restraints to force-feed hunger strikers for more than a handful of episodes, much less for weeks and months (and in at least one case, years) at a time,” the report declares. Yet, since 2006, the use of restraint chairs have been normalized and any prisoner engaged in a hunger strike is likely to be fed in a restraint chair, even if that prisoner’s health does not face serious risks from not eating.

The report challenges the Defense Department and states that “available evidence suggests that force-feeding has been used commonly, not just in rare instances where a detainee’s life was threatened.” Therefore, the claim that force-feedings are only used to save lives is “not credible.”

It points to a new policy established by the Joint Medical Group at Guantanamo in March 2013, which the Task Force says, like previous policies, views hunger strikes as a “security issue.”

“The new policy is even more punitive than those employed in the past and exacerbates the features of US hunger strike policy at Guantanamo that already violate international standards,” the Task Force argues. “The Task Force further concludes that by entangling physicians and nurses in a punitive approach to hunger strikes and requiring them to depart from duties of respect for patient autonomy and exercise of independent professional judgment, the DoD assigns a role to physicians and nurses that is unethical.”

A prisoner used to be able to control the rate that food was entering his body to limit discomfort. But, “in a major policy change from the past that adds to the coerciveness of force-feeding, the detainee is no longer permitted to control drip rates or order of ingredients during enteral feeding.” The new standard operating procedure states that giving prisoners this kind of control “has had the effect of prolonging the total time spent in the feeding chair and has given the detainee a measure of control over an involuntary process.” Therefore, the Task Force indicates “all elements
of detainee control over flow rate, content of feeding, or location of feeding is now prohibited.”

Furthermore, the Task Force maintains its conclusions are “consistent with decisions of courts reviewing similar practices. The European Court of Human Rights, while stating that force-feeding to save a life may not amount to a violation of laws against torture and cruel, inhuman, or degrading treatment, held that ‘repeated force-feeding, not prompted by valid medical reasons but rather with the aim of forcing the applicant to stop his protest, and performed in a manner which unnecessarily exposed him to great physical pain and humiliation, can only be considered as torture.’”

The World Medical Association’s guideline for medical professionals is the following:

Forcible 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. Equally unacceptable is the forced feeding of some detainees in order to intimidate or coerce other hunger strikers to stop fasting.

In the recounting of history at Guantanamo in the report, it is evident that prison officials tolerated hunger strikes to some extent up until 2005. Representatives from the prison met with certain detainees to discuss improving conditions of confinement. However, by 2006, policy changed dramatically, and the prison put more focus on suppressing hunger strikes whenever they immediately began.

Captain Edmondson, who was commander of the Joint Medical Group at Guantanamo from July 2003 to January 2006, stated in an official declaration, that physicians were to make recommendations for enteral or force-feedings. The practice at the prison in 2005 was to use a “size 10 French or a size 12 French feeding tube, one-eighth and one-seventh of an inch in diameter, respectively.” The nasogastric tube would be inserted into the nostril of the prisoner after being offered a topical anesthetic for his nostril and throat. The tube was to be lubricated and sterilized.

He also suggested that (up until October 2005) prisoners had accepted the nasogastric tube “without force or restraints.” Whether this means they acquiesced or failed to physically resist is unclear, but Edmondson stated that hunger strikers did not resist feeding tubes and “10 detainees had been subjected to the use of four-point restraints to accomplish insertion.” They controlled the “flow of nutrients through the tube.” Some detainees who remained in their cell would voluntarily have the nurse connect bags of nutrition and, while they were being fed, they would “walk around their cells in the process.”

This conflicts greatly with prisoner accounts of the process. The Task Force notes that “one detainee claimed that the extraction of the tubes was so painful that it sometimes resulted in blood gushing out, leading to fainting. One detainee alleged that lesions and bleeding occurred when guards held him by the chin and hair while strapped down as a medical staffer ‘forcefully inserted the tube in his nose and down his throat.’”

Abdul-Rahman Shalabi apparently claimed that one US Navy doctor had “inserted the nasogastric tube in his throat and kept moving the tube up and down until finally he started violently throwing up blood.” His lawyer wrote a declaration that read, “Abdul-Rahman tried to resist what he called the ‘torture’ from this physician but he could not breathe. He was suffocating and when the tube that had been jabbing him internally was finally removed, it was full of blood.”

The Task Force further outlines how, in late 2005, “five restraint chairs” were introduced into the force-feeding process, which the prison claimed were “needed to prevent detainees from disgorging food and to make force-feeding more controlled.” Twenty more chairs arrived in January.

The chair would restrain the prisoner’s arms, legs, chest and forehead. And, according to the Task Force:

…Once the detainee was immobilized in a restraint chair, medical staff would insert the nasogastric tube via the esophagus into the stomach and administer liquid nutrients over a period of around 30–50 minutes. the detainee would often remain immobilized for a further 60–90 minutes. This additional period was introduced to prevent the prisoner from using the outside end of the nasogastric tube as a “straw” to siphon off the contents of his stomach before it was digested. The force-feeding procedure was performed twice a day on each detainee…

Use of the restraint chairs was clearly intended to stifle resistance among prisoners.

“A US Navy forensic psychiatrist and three experts from the Bureau of Prisons,” argued in December 2005, according to the Task Force, that hunger strikes happened to be a “discipline issue and that the failure to eat was a violation of camp rules.” This helps to explain why, in addition to having a tube shoved down’s one nose for hunger striking, many prisoners is also put into conditions of solitary confinement (some for 22 hours a day). They were also deprived of comfort items like “blankets and books,” and “riot-control soldiers” were utilized when nasogastric tubes were to be inserted for force-feedings.

One detainee, Jum’ah Aldossari, was told that if hunger strikers “challenged the United States, the United States would challenge them back using these tactics.” The fear of being brutally force-fed and the screams heard from prisoners being force-fed would induce fear, convincing prisoners to abandon their protest.

A remarkable aspect of the Task Force report is how it recognizes that the prison authorities has regarded hunger strikes as “blackmail.” It is made clear that medical personnel are not to be agents of the security apparatus and help prison officials suppress protest through the employment of any procedure that could be construed as medical treatment. But that is exactly what has taken place at Guantanamo.

Medical staff following “command-level protocol” have directly inflicted torture or cruel, inhuman or degrading treatment. Any physicians who would not participate were “screened out to prevent their deployment to Guantanamo.”

Physicians are currently instructed to make it clear at the outset if they cannot treat or artificially feed a hunger striker for “reasons of conscience” so that hunger striker can be “treated” by “another physician who is willing to abide by the hunger striker’s refusal.”

The Task Force calls for force-feedings and the use of physical restraints to be prohibited and concludes, “Far from being humane, the use of force-feeding over the past decade violates the human rights of detainees and has led physicians and nurses to commit serious breaches of their professional standards. Moreover, detainees have been force-fed for weeks and months at a time. The Task Force is not aware of any precedent for ‘managing’ hunger strikes for such a long period, lasting over months, and in some cases years.”

“Neither the World Medical Association nor any standard-setting authority ever contemplated multiple force-feedings in a restraint chair over the course of weeks, much less months and years, as has been the practice at Guantánamo.”

What the Task Force report shows is that the US military has systematically and brutally tortured a group of human beings, who have been deprived of due process, for daring to challenge the authorities directly involved in maintaining a structure that has violated their rights daily.

Many prisoners have been in detention for ten to twelve years and have not been charged with any crimes. Suffering at the hands of prison guards should be enough to negate any evidence or intelligence the US government has against many of the prisoners. A decent society would send people back to their home countries after this sort of treatment. Sadly, the Guantanamo military commission has been setup to ignore evidence of torture from defendants so it does not get in the way of prosecutions.

There have been no consequences for the barbarism that has occurred in the prison. All involved have escaped punishment for their actions and, because Obama decriminalized torture, it is not likely that anyone involved or responsible for this horror will ever do jail time.