Isidingo - The Need

While George W Bush accounts for the state of the nation there are certain subjects he avoids…such as the on-going detention of prisoners in Guantanamo Bay and the force-feeding of hunger strikers. ..speaks to some of those involved…

“About a dozen guards led me from my cell to the medical unit. There they straitjacketed me, tied me to a bed, and sat on my legs so that I would not jerk. The others held my shoulders and my head while a doctor was pushing the feeding tube into my nostril.
The feeding pipe was thick, thicker than my nostril, and would not go in. Blood came gushing out of my nose and tears down my cheeks, but they kept pushing until the cartilages cracked. I guess I would have screamed if I could, but I could not with the pipe in my throat. I could breathe neither in nor out at first; I wheezed like a drowning man -- my lungs felt ready to burst. The doctor also seemed ready to burst into tears, but she kept shoving the pipe farther and farther down. Only when it reached my stomach could I resume breathing, carefully. Then she poured some slop through a funnel into the pipe that would choke me if it came back up. They held me down for another half-hour so that the liquid was absorbed by my stomach and could not be vomited back, and then began to pull the pipe out bit by bit. . . . Grrrr. There had just been time for everything to start healing during the night when they came back in the morning and did it all over again,” Soviet dissident Vladimir Bukovsky wrote in the Washington Post, in an article that brings home the horror institutionalised force feeding. Bukovsky spent nearly 12 years in Soviet prisons where he was regularly force fed after going on a hunger strike.
So he and other activists around the world have been particularly outraged that hunger striking detainees at Guantanamo have been subjected to this controversial procedure. The US military denies that their force feeding of inmates at Guantanamo is anything like the torture described by Bukovsky.
“Force feeding is a misleading term,” insists LTC Jeremy M. Martin, Director of Public Affairs, Joint Task Force Guantanamo Bay. “Detainees are tube fed when required, in a prudent manner by doctors or registered nurses. This feeding is consistent with what occurs in US hospitals or US correctional facilities. Tube feeding is performed humanely. Detainees on hunger strike are treated humanely.
“Detainees are not sedated during tube feeding, are given a mild local anesthetic if requested. Detainees are sitting up-right when tube feeding occurs, and the process lasts 1-2 hours. DoD policy is to preserve life by appropriate, lawful, clinical means.”
But the latest row to hit the military has not been about the humaneness or cruelty of the procedure, rather the ethics of those involved.
US Defence Secretary Donald Rumsfeld speaking about the issue to a Pentagon press conference in November 2005, said, “I’m not a doctor and I'm not the kind of a person who would be in a position to approve or disapprove."
He had the political savvy to distance himself from what would turn out to be an international storm of protest and a brewing legal drama. This public washing of hands may seem to make Rumsfeld untouchable for what in some people’s minds amounts to war crimes, but some of his minions are feeling the backlash of judicial and international sentiment.
London solicitors Allen and Overy, who represent some of the detainees at Gitmo, have filed court action in California, asking the judiciary to look into the ethical liability of Captain John S Edmondson, then commander of Guantanamo's hospital,
The procedures are carried out by licensed doctors, which brings them into conflict with the World Medical Association. Whether or not that has any jurisdiction over Captain Edmondson is still being decided by the San Diego courts.
The military's policy of tube feeding prisoners on hunger strike is controversial, and military health care providers are "screened" before deployment to Guantanamo "to ensure that they do not have ethical objections to assisted feeding," Captain Edmondson told Susan Okie, M.D. who wrote about her October visit to Guantanamo in December’s issue of the New England Journal of Medicine.
But, according to Nepalese Dr Bhogendra Sharma, (telephone interview) international programme advisor of medical foundation Medical Foundation for the Care of Victims of Torture the practice is unethical. “It is the Duty of doctors to respect the autonomy a person has as a patient.” To carry our any sort of procedure, he said, the doctor needed the “informed consent of his patient”.
In his sworn affidavit, seen by the South China Morning Post, Captain Edmondson states “The actual feeding process, both at the detention hospital and on the cell block, is very voluntary. Detainees retain a large measure of control over the administration of the nutrition. Once the feeding tube is inserted (or if it has remained in the detainee) a bag is connected to the tube and the nutrition flow begins. The detainee himself controls the flow of the nutrition so that any discomfort is minimized. . . . The detainees within their cells come voluntarily to the door and hand their naso-gastric tube out to a nurse, who connects the bag of nutrition to the tube and hangs the bag connected to the tube on a hook outside the cell door. … The length of the tube allows the detainee to move about within his cell for the two hours of feeding.”
Dr Sharma is puzzled by this assertion. If detainees were willing to receive nutrition, he wonders, why not just eat instead of going through the discomfort of tube feeding.
He, like many other vocal activists believes this is a form of torture.
“Force feeding is very painful,” he says. “It can be used as a form of coercion.”
The recent trial of Chief Warrant Officer Lewis Welshofer in the death during interrogation of Iraqi Maj. Gen. Abed Hamed Mowhoush, the shocking photographs from Abu Ghraib, affidavits of detainees telling of beatings, sexual assaults and religious pressures and the United States’ history of torture have badly dented America’s image.
So it is perhaps understandable that LTC Martin, is at pains to point out that this is not “force feeding” but rather a medical intervention to save the lives of detainees under the department’s care.
No prisoner has died at Guantanamo Bay. The officers are justifiably proud of this record and aim to keep it that way. Activist UK neurologist David Nicholl (telephone interview) believes it is this very record which is helping to motivate the medical staff to cross the ethical boundaries.
“It’s a face-saving effort,” he says.

On 11 January, Captain Edmondson handed over command of US Naval Hospital Guantanamo Bay to Captain Ronald L Sollock, MC, USN. In a move that raised eyebrows among activists, he was awarded his third Legion of Merit Medal. His new task will be head of the Future Operations Division of the Bureau of Medicine and Surgery.
Dr Nicholl wrote a strongly worded letter to Captain Edmondson, calling him out on the ethics of this dispute and pointing out: “I would thus urge you to consider very carefully the consequences of your current actions, which are in direct contravention of internationally agreed legal and ethical standards, that have been ratified by the American
Medical Association, amongst others. I suggest that following these guidelines, you
should stop any further involuntary feeding. In the UK, we stopped force-feeding inmates 100 years ago with the suffragettes as the practice was felt to be barbaric then, it still is.”
The British government faced this exact dilemma during its incarceration of Irish Republican Army members and allowed them to starve to death, he said in his interview
Captain Edmonson replies: “You have a responsibility to base your conclusion on facts. Not on the accusations leveled [sic] in the media and broadcast by defense attorneys who are more interested in publicity than in the rights or health of their clients. In actuality I am not currently force feeding any detainees. I am providing nutritional supplementation on a voluntary basis to detainees who wish to protest their confinement by not taking oral nourishment.”
Yet in his affidavit he mentions prisoners having to be restrained, of them removing their tubes.
One of the greatest problems the media faces in reporting the truth is that the only non-partisan organisation allowed unfettered access to the detainees and facilities at Guantanamo Bay is the Red Cross.
And they, for fear of losing this right, do not make public their reports. “Access to every person in every conflict zone who needs protection or help, everywhere in the world, is our raison d’être. One thing is clear: if parties to a conflict see us leaking what we know to the outside world, the chances of our operating effectively will shrink dramatically But like I say, confidentiality is not what it’s actually about.” ICRC president Jakob Kellenberger says in an article on the ICRC’s website.
The media has been invited to the facility for carefully managed PR tours and many of them decline.
Even the UN special rapporteur on torture, Manfred Nowak, has not received the access he has requested.
So for now, Guantanamo Bay remains a festering sore on the face of human rights, under the auspices of the country that styles itself as the paragon of such rights.
And Bukovsky’s words ring true. “Think what effect your attitude has on the rest of the world, particularly in the countries where torture is still common, such as Russia, and where its citizens are still trying to combat it. Mr. Putin will be the first to say: "You see, even your vaunted American democracy cannot defend itself without resorting to torture."