Force-feeding

"As described below, the U.S. military has admitted to force-feeding prisoners at Guantánamo who are participating in hunger strikes. Although the ICRC stated that the indefinite detention and current conditions at Guantánamo are “tantamount to torture,” it is difficult to assess the ethical obligations of military medical personnel at Guantánamo without further information about the treatment of detainees and the psychological impact of their indefinite detention. The prisoners’ families, moreover, have little or no knowledge of whether their sons or husbands are participating in a strike. And if their relatives are participating in a protest, military medical personnel have not informed the families of their relatives’ health status or their wishes concerning nourishment. This failure contradicts the policy of the WMA that a “doctor has a responsibility to inform the family of the patient that the patient has embarked on a hunger strike, unless this is specifically prohibited by the patient.”"

"The first coordinated large-scale mass protest at Guantánamo began on February 27, 2002 when prisoners initiated a rolling hunger strike. This hunger strike appears to have started when an MP removed a homemade turban from a prisoner during his prayer. As the hunger strike expanded to a peak of 194 participants over a two-month period, it became a protest of the prisoners’ indefinite detention without any legal process and their harsh living conditions. A spokesman for the Guantánamo Joint Task Force, Marine Captain Alan Crouch, acknowledged in a February 28, 2002 official statement that 159 prisoners refused lunch and 109 refused dinner on February 27, 2002. On February 28th, 107 refused breakfast and 194 did not eat dinner. At the beginning of the hunger strike, the military attempted to minimize the seriousness of the protest. In a prepared statement, a Joint Task Force public affairs officer, Marine Major Steve Cox, stated that “[b]y no means is this an organized, concerted effort by the camp’s detainee population, but merely a demonstration of some of the detainees’ displeasure over the uncertainty of their future.” Several days into the hunger strike, Brig. Gen. John W. Rosa, Jr., Deputy Director for Operations, Joint Chiefs of Staff, stated that the detention center commander and the chaplain “have been out and around with and speaking to the detainees. The tensions have eased in their opinion.” But by mid-March, three detainees who had refused food and water for approximately fourteen days were forcibly given intravenous fluids. By this time, military officials were acknowledging that the prisoners were protesting “the fact that they don’t know what is happening to them” and that the hunger strike participants’ primary concern was “their murky future.” In early May, only two prisoners continued to participate in this hunger strike. Both men had been striking since March 1, 2002 to protest their indefinite detention. The military returned one man to Camp Delta on May 2, 2002 after force-feeding him, ending his 63-day hunger strike. The other final participant was forcibly fed through a tube inserted in his nose on May 10, 2002 after 71 days of fasting."

"U.S. Immigration and Customs Enforcement, or ICE, is force-feeding nine detainees who are on a hunger strike at a detention center in El Paso, Texas. The protesters are mostly from India and are being held in ICE custody while their asylum or immigration cases are processed. Since the beginning of the year, they have been protesting their detainment and mistreatment by guards who they allege have threatened them with deportation and withheld information about their cases, according to the detainees’ lawyers. In mid-January, a federal court ordered ICE to force-feed the strikers. An ICE official stated: “For their health and safety, ICE closely monitors the food and water intake of those detainees identified as being on a hunger strike.” ICE policy states that the agency authorizes “involuntary medical treatment” if a detainee’s health is threatened by hunger striking. Force-feeding involves tying a detainee to a bed, inserting a feeding tube down the nose and esophagus and pumping liquid nutrition into the stomach. ICE detainees have reported rectal bleeding and vomiting as a consequence of being force-fed."

"Hunger strikes have plagued Guantánamo since it opened in 2002. In one of the largest hunger strikes to occur in a U.S. detention facility, about 500 detainees stopped eating under the slogan “starvation until death” in late June 2005. They began this strike to protest the conditions of their confinement, including alleged beatings, abuse of their religious freedom by mishandling the Koran and indefinite detention without trial. In response, military doctors authorized “involuntary intravenous hydration and/or enteral tube feeding” – in other words, IV treatment and force-feeding. Prisoners found ways to get around the feedings, like making themselves vomit or siphoning out their stomachs by sucking on the external end of the feeding tube. The strike overwhelmed camp commanders. In December 2005, they called in help from the Federal Bureau of Prisons, which had previously authorized force-feeding. The consultants observed as strikers were force-fed twice a day and recommended using the emergency restraint chair, a “padded cell on wheels.” That requires strapping detainees down onto the chair, making it easier for guards to insert and remove a feeding tube. Detainees referred to it as the “execution chair.” This had the desired effect on the prisoners: Only a handful continued the hunger strike and it was over by February 2006. The camp ordered 20 more chairs."

"In 2013, a widespread hunger strike again swept through Guantánamo – 106 of 166 prisoners participated. Forty-one detainees met the requirements for being force-fed: skipping nine consecutive meals or their BMI dropping below 85 percent of their intake weight. One participant, Samir Naji al Hasan Moqbel, a Yemini citizen detained for 11 years, told The New York Times, “I had never experienced such pain” as from the feedings."

"Guantánamo hunger strikers filed lawsuits against the U.S. government for force-feeding prisoners and using the restraint chair. Several judges ruled that force-feedings are legal. In one case, a judge wrote that it did not constitute a violation of the Eighth Amendment against cruel and unusual punishment. Rather, she wrote that administrators “are acting out of a need to preserve the life of the Petitioners rather than letting them die.” This contradicts what many experts the medical and human rights professionals have said about force-feeding. The World Medical Association, an international medical ethics organization, asserted that force-feeding is “unjustifiable.” Organizations ranging from the ACLU to Human Rights Watch condemn the practice as “inherently cruel, inhuman, and degrading.”"

"While the courts can authorize interventions requested by the government such as force-feeding, immigrant detainees have limited power to appeal to courts about the conditions of their detention. As with the Guantánamo detainees, migrants are risking starvation, but not because they want to die. As Amrit Singh, the uncle of two men being force-fed, stated, “They want to know why they are still in the jail and want to get their rights and wake up the government immigration system.” Hunger striking offers one of few ways they can protest their prolonged confinement in pursuit of this goal."

"Eventually eight of the women received sentences of imprisonment varying from one month to fourteen days, whilst Charlotte Marsh was sent to prison for three months' hard labour, and Mrs. Leigh for four. We knew that Mrs. Leigh and her comrades in the Birmingham Prison would carry out the hunger strike, and, on the following Friday, September 24th, reports appeared in the Press that the Government had resorted to the horrible expedient of feeding them by force by means of a tube passed into the stomach. Filled with concern the committee of the Women's Social and Political Union at once applied both to the prison and to the Home Office to know if this were true but all information was refused. The W. S. P. U. now made inquiries as to the probable results of this treatment, and were informed that it was liable to cause laceration of the throat and grave and permanent injury to the digestive functions, and that, especially if the patient should resist, as the tube was being inserted or withdrawn there was serious danger of its going astray and penetrating the lungs or some other vital part. The whole operation, together with all the attendant circumstances, could not fail to put a most excessive strain upon the heart and the entire nervous system, and, if there were any heart weakness, death might ensue at any moment. In the Lancet for September 28th, 1872, a case was reported of a man under sentence of death, who had been forcibly fed by means of the stomach pump, that is to say by means of an india-rubber tube passed through the mouth into the stomach, the method used in the case of the Suffragettes. The man had died. In the same issue of the Lancet, appeared the opinion upon this question of several prominent medical men. Dr. Anderson Moxey, M.D,, M.R.C.P., had said: " If anyone were to ask me to name the worst possible treatment for suicidal starvation I should say unhesitatingly, forcible feeding by means of the stomach pump." Dr. Tennant stated that this method of feeding produced " an incentive to resistance," and that the exhaustion thereby introduced was sometimes so great as to cause death by syncope. Dr. Russell had met with a case in which death had occurred immediately after the placing of the tube " before it could be withdrawn, much less used " ; and Dr. Conolly was " appalled by the dangers resulting from the forcible administration of food by the mouth." Amongst the various important medical experts consulted by The Women's Social and Political Union was Dr. Forbes Winslow, whose wide experience in cases of insanity could not be questioned. When asked professionally to give his views on the subject he said: So far as the stomach pump is concerned it is an instrument I have long ago discontinued using, even in the most serious cases of melancholia, where the victim, perhaps from some religious delusion, refuses all nourishment. It possibly may be regarde by some as the most simple means of administering food, but this I challenge by saying at once that it is the most complicated and the most dangerous. . . . I have known some of the most serious injuries inflicted by the persistent use of the stomach pump. I have known a case in which the tongue has been partly bitten off where it had been twisted behind the feeding tube. He added that forcible feeding was especially dangerous in cases of heart and lung weakness or of rupture or hernia, and that the result of persistent use would be to seriously injure the constitution, to lacerate the parts surrounding the mouth, to break and ruin the teeth."

"When the House of Commons met on Monday we learnt that our fears were only too well founded for Mr. Keir Hardie drew from Mr. Masterman who spoke on the Home Secretary’s behalf, the admission that the Suffragettes in Wison Green Gaol were being forcibly fed by means of a tube which pas passed through the mouth and into the stomach and through which the food was pumped. The unprecedented and outrageous nature of the assault was glossed over by the use of the term, “Hospital treatment,” in connection with it. Mr. Masterman admitted, however, that there were no regulations which authorized the proceeding, but he stated that it was resorted to in the case of men and women prisoners who were “weak minded” or “contumacious”. Mr. Hardie’s indignant protest and reminder that the last man prisoner to whom such treatment had been meted out had died under it, were met with shouts of laughter by the supporters of the Government. Horrified by their heartless and unseemly levity in the face of so serious a question, he at once addressed a statement to the Press in which he declared that he " could not have believed that a body of gentlemen could have found reason for mirth and applause " in a scene which had " no parallel in the recent history of our country." As far as he could learn, no power to feed by force had been given to prison authorities, save in the case of persons certified to be insane. He concluded by warning the public of the danger that one of the prisoners would succumb to the so-called "hospital treatment," and by appealing to the people of these islands to speak out ere our annals had been stained by such a tragedy. Others hastened to second this protest. Mr. C. Mansell-MouUin, M.D., F.R.C.S., wrote to The Times, as a hospital surgeon of thirty years' standing, to indignantly repudiate Mr. Masterman's use of the term " hospital treatment," declaring that it was a " foul libel " for that " violence and brutality have no place in hospitals as Mr. Masterman ought to know." Dr. Forbes Ross of Harley Street wrote to the Press saying: As a medical man, without any particular feeling for the cause of the Suffragettes, I consider that forcible feeding by the methods employed is an act of brutality beyond common endurance, and I am astounded that it is possible for Members of Parliament, with mothers, wives and sisters of their own, to allow it. A memorial signed by ii6 doctors, headed by Sir Victor Horsley, F.R.C.S., W. Hugh Fenton, M.D. M.A., C. Mansell-MouUin, M.D., F.R.C.S., Forbes Winslow, M.D., and Alexander Haig, M.D., F.R.C.P., was organised by Dr. Flora Murray and addressed to Mr. Asquith, protesting against the artificial feeding of the Suffragette prisoners, on the ground that it was attended by the gravest risks and was both unwise and inhuman. To this memorial many of the doctors added descriptive notes of their own. Mr. W. A. Davidson, M.D., F.R.C.S., wrote: " A most cruel and brutal procedure. Were the tubes clean? Were they new? If not they have probably been used for people suffering from some disease. The inside of the tube cannot well be cleaned; very often the trouble is not taken to clean them." In spite of every form of discouragement and ridicule, Mr. Keir Hardie continued constantly to raise the question of forcible feeding in the House of Commons only to be met by evasive, and sometimes grossly, inaccurate replies from the Home Office. Mr. Gladstone tried to shelter himself behind the officials who were his subordinates, and to place the responsibility on the medical officers. For this he was strongly condemned by the British Medical Journal which characterised his conduct as contemptible.*"

"In reply to the protests of medical men and the memorial from doctors, which had been addressed to him, Mr. Gladstone succeeded in drawing a statement from Sir Richard Douglas Powell, the President of the Royal College of Physicians, who said that he thought the memorial exaggerated, though he admitted that forcible feeding was not " wholly free from possibilities of accident with those who resist." He added that, in dissenting from the view expressed by the memorialists, he was assuming that the feeding of the prison patients was " entirely carried out by skilled nursing attendants under careful medical observation and control." We, of course, know that this was not the case. A large number of doctors, including Dr. R. G. Layton, physician to the Walsall hospital, replied to Sir Douglas Powell by again recapitulating the dangers of forcible feeding. But indeed the opinions of medical men were unnecessary to those who afterwards came in contact with the women who had been forcibly fed. Their exhausted condition was a form of evidence that no argument could upset. It is important to note also that during the year 1910 two ordinary criminals, a man. and a woman, were subjected to forcible feeding. The man died during the first operation; the woman committed suicide after the second."

"From 1905 until the outbreak of the First World War in August 1914 about 1000 women were sent to prison because of their suffrage activities, most of these being members of the WSPU... While these prison ‘experiences’ have not been ignored by historians, they have been discussed as a part of a broader account of the suffrage movement rather than focused upon in depth as a subject worthy of investigation. Furthermore, a dominant narrative of these experiences has emerged which [asserts] that the women themselves were to blame for their often harsh prison experiences, including the pain of hungerstriking and forcible feeding...."

"Early histories of the suffrage movement present a more sympathetic picture of prison life than many subsequent accounts. Metcalfe, for example, writing in 1917, speaks of the “scenes of horror which had taken place in Holloway and other prisons ... in the unavailing effort to govern women against their consent”. However, it is the history written by the constitutional suffragist, Ray Strachey, a member of the NUWSS and hostile to the WSPU, that became the influential text. Strachey blames the WSPU women themselves for the treatment they received... Unwilling to acknowledge the hunger strike as a political tool, Strachey comments how the suffragettes, once in prison, ceased to be militant and created a number of protests including the refusal to eat food. “Forcible feeding was tried in vain”, she continues; “the prisoners struggled so violently against it that the process became actually dangerous, and the prison officials were obliged to let them starve till they came to the edge of physical collapse, and then to let them go”. In spite of the severe pain and damage to health which the process involved, “scores of suffragettes adopted it ... The officials tried everything they could think of in vain ...”. This picture of irrational women, deliberately seeking their own torture was eagerly seized upon by male historians who sought to ridicule the WSPU and its politics. George Dangerfield’s The Strange Death of Liberal England, first published in 1935, discusses the suffragette movement as... a form of “pre-war lesbianism” of “daring ladies”... Dangerfield too presents the suffragettes as fanatical women who chose the hardships of prison life in a sado-masochistic way ... “How can one avoid the thought”, he questions, “that they sought these sufferings with an enraptured, a positively unhealthy pleasure?” If the victim does not resist, “forcible feeding is no more than extremely unpleasant. But the suffragettes were determined to resist”. In view of the fact that Dangerfield’s account contained no footnotes whatsoever to primary sources to support his claims, it is incredulous that his analysis was received so enthusiastically and became so influential. The Times and Tribune, for example, hailed it as “brilliant”... Thus the scene of the drama is set and the props are changed only with slight variations. Roger Fulford in 1957... mocked their prison experiences, claiming that solitary confinement in prison was “not always unwelcome to adults”. Furthermore, although “forcible feeding is a disgusting topic ... it was not dangerous ... [It] is of course a familiar form of treatment in lunatic asylums”. While Andrew Rosen is much more sympathetic to the women prisoners, he too, in a matter of fact way speaks of how forcible feeding involved mouths being prised open, lacerations, phlegm, vomiting, pain in various organs, loss of weight “and so on”..."

"Hunger striking and force feeding were acts committed by, and on, individuals in their own cells. Whether force fed by a cup, tube through the nostril (the most common method) or tube down the throat into the stomach (the most painful), the individual suffragette struggled on her own and often feared damage to the mind or body. Kitty Marion’s screaming in prison greatly upset the other women, but she found it was the only way she could fight against the torture of forcible feeding and remain sane. Rachel Peace, an embroideress, who had already experienced several nervous breakdowns, was not so fortunate. During a period of prolonged hunger striking and forcible feeding three times a day she feared, “I should go mad ... Old distressing symptoms have re-appeared. I have frightful dreams and am struggling with mad people half the night”. Her fears became true when she “lost her reason in prison” and spent the rest of her life in and out of asylums, with Lady Constance Lytton, an upper-middle-class WSPU worker, maintaining her. The forcible feeding of the disabled May Billinghurst in Holloway in January 1913 brought a particular wave of revulsion since she was “small, frail, and ha[d] been a cripple all her life”. Paralysed as a child and confined to a tricycle for mobility, she told how the three doctors and five wardresses who held her down: “forced a tube up my nostril; it was frightful agony, as my nostril is small. I coughed it up so that it didn’t go down my throat. They then were going to try the other nostril, which, I believe is a little deformed. They forced my mouth open with an iron instrument, and poured some food into my mouth. They pinched my nose and throat to make me swallow”. After 10 days of “almost incredible suffering”, when she was fed three times every 24 hours, she was released “a physical wreck”. Margaret Thompson, in prison in 1912, had a facial disability, resulting from a car accident; after examining her face to see if it was “fit” for forcible feeding, the doctor decided she should be fed by the cup rather than the tube. Miss McCrae, in prison at the same time, thought she too should take food through the cup, on account of her deafness, although she feared the other women would scorn her for doing so. For women with disabilities such as those mentioned here, imprisonment and forcible feeding were particular acts of courage."

"For many of these women, the worst feature of prison life was the ‘public’ violation of their bodies when being forcibly fed. Helen Gordon Liddle hated the lack of privacy when enduring the pain of forced feeding. Nell Hall spoke of the “frightful indignity” of it all. For Sylvia Pankhurst, the sense of degradation endured was worse than the pain of sore and bleeding gums, with bits of loose jagged flesh, the agony of coughing up the tube three or four times before it was successfully inserted, the bruising of her shoulders and the aching of her back. Sometimes, when the struggle was over, or even in the heat of it, she felt as though she was broken up into many different selves, of which one, aloof and calm, surveyed all the misery, and one, ruthless and unswerving, forced the weak, shrinking body to its ordeal. Although the word ‘rape’ is not used in the personal accounts of force fed victims, the instrumental invasion of the body, accompanied by overpowering physical force, great suffering and humiliation was akin to it, especially so for women fed through the rectum or vagina. 'Janet Arthur’, later identified as Fanny Parker, in Perth prison in 1914, was one such victim: Thursday morning, 16th July ... the three wardresses appeared again. One of them said that if I did not resist, she would send the others away and do what she had come to do as gently and as decently as possible. I consented. This was another attempt to feed me by the rectum, and was done in a cruel way, causing me great pain. She returned some time later and said she had ‘something else’ to do. I took it to be another attempt to feed me in the same way, but it proved to be a grosser and more indecent outrage, which could have been done for no other purpose than torture. It was followed by soreness, which lasted for several days. When released, a medical examination revealed swelling and rawness in the genital region. The knowledge that new tubes were not always available and that used tubes may have been previously inflicted on diseased persons and the mentally ill or be dirty inside the tube, issues that had been openly discussed in Votes for Women, undoubtedly added to the feelings of abuse, dirtiness and indecency that the women felt."

"Big has long been considered beautiful in Mauritania. But now, a generation of women are abandoning an ancient practice to fatten up – and some are even redefining beauty to put their health first. It's not a lifetime spent scoffing junk food and slurping fizzy drinks that's to blame for obesity here; rather, a tradition as old as the desert: gavage. On the tree-lined boulevards of Paris, the French word describes the process of fattening up geese to produce foie gras. On the sand-blanketed streets of Mauritania's capital, Nouakchott, it describes the process of forcibly funneling sweetened milk and millet porridge down the throats of young girls. In this vast nomadic nation, thin women are an admission of poverty. Voluptuous wives and daughters, by contrast, are displays of a man's wealth, and that's where force-feeding comes in. After campaigns at the national and community level, the brutal practice is on the way out. The latest government survey, in 2001, estimated that about 10 percent of women ages 15-19 were force-fed as young girls, down from 35 percent among 45 to 54-year-olds. But that older generation of women is now battling a variety of illnesses as well as child-bearing complications, doctors and midwives say. "Even getting out of bed is difficult for some of them, never mind working," says Mariame Baba Sy, the head of a government commission on women's issues."

"While it's clear that the practice of force-feeding women is on the decline, the government doesn't keep statistics on obesity, or track if the decline in gavage is translating into a slimmer, healthier population. Indeed, some young girls may just be turning to a less painful way to meet the Mauritanian beauty ideal. "The real gavage is on the point of becoming extinct. But there's a new method," says Ms. Baba Sy. "They take pills, some of them ones you usually give to an animal.""

"After being force-fed as a child, M'haimid now won't touch milk or millet, staples that were pumped into her every two hours, even when she kept vomiting. While she talks proudly about the 22 lbs. she has lost in the past month, she knows that at 264 lbs., she cannot rest. "My husband tells me not to tire myself out with this weight loss. These Mauritanian men, they still love fat women. But my health is more important," she says. Mariam Aicha, a former mayor of Nouakchott, recalls a doctor addressing delegates at a recent conference on health. "He said that, from his professional point of view, it was the thinner the better, but then admitted that as a man, he liked something to hold on to," she says."

"The UN war crimes tribunal in The Hague last night ordered the force-feeding of a Serbian warlord and senior politician who has been on hunger strike in custody for almost a month. The decision, the first such order since the court was set up more than a decade ago to deal with war crimes in the former Yugoslavia, came after a medical examination of Vojislav Seselj concluded that he might be a fortnight away from dying."

"The tribunal last night told Dutch authorities to force-feed Mr Seselj if there was a risk of him dying. "There is a prevailing interest in continuing with the trial of the accused in order to serve the ends of justice," it said in a statement. "The trial ... should not be undermined by the accused's manipulative behaviour." Mr Seselj, who surrendered to The Hague tribunal more than three years ago, has consistently sought to use the court as a stage to belittle and mock the institution. He went on hunger strike last month to demand unlimited conjugal visits and the opening of frozen bank accounts in the US, he insisted on defending himself at the trial and has hurled abuse at anyone who contradicts him."

"Last night's statement from the tribunal was the first time it had resorted to such orders. It appears anxious to avoid creating another Serbian "martyr" after Milosevic died in its custody this year. Another Serbian warlord, Milan Babic, the former Croatian Serb leader, committed suicide while in custody. The tribunal said it had issued an "urgent order to the Dutch authorities" to ensure Mr Seselj did not die as a result of his hunger strike, now in its 27th day. While stating that any force-feeding deemed necessary for lifesaving purposes should not contradict "compelling internationally accepted standards of medical ethics or binding rules of international law", the judges at the tribunal also noted that the body of law laid down by the European court of human rights did not view force-feeding as "torture, inhuman or degrading treatment if there is a medical necessity to do so ... and if the manner in which the detainee is force-fed is not inhuman or degrading"."