What Does a 16-Year Hunger Strike Do to Your Body?

On Tuesday, Irom "Mengoubi" Chanu Sharmila of Manipur in northeast India ended her nearly 16-year hunger strike by licking a smudge of honey off of her hand, but what effect has the strike had on her body?
August 12, 2016, 6:03pm

Photo via Getty/Hindustan Times

On Tuesday, Irom "Mengoubi" Chanu Sharmila of Manipur in northeast India ended her nearly 16-year hunger strike by licking a smudge of honey off of her hand. The 44-year-old began her strike 5,757 days prior, following the November 2000 Malom Massacre, wherein men from the Assam Rifles paramilitary force killed ten civilians at a bus stop near the regional capital of Imphal and faced no consequences. Sharmila aimed to force the repeal of the Armed Forces Special Powers Act, which grants armed forces legal impunity and broad authority to violate civil rights in the name of "security" in restive parts of the country. The AFSPA still stands in India, but Irom's fortitude earned her a 2005 Nobel peace prize nomination and a moniker: The Iron Lady of Manipur.

In the days since she called off her strike, most have focused on what comes next for Irom, who spent most of the last 16 years relatively isolated in police custody at Imphal's Jawaharlal Nehru Hospital—ironically, named after the Prime Minister whose government passed the AFSPA. Despite India's tradition of hunger strike activism , authorities labeled Irom's a possible illegal suicide attempt and forced her to reaffirm her strike periodically to re-arrest her on new charges, circumventing a law against holding a prisoner before trial for over a year.

Irom was released on $149 bail when she announced the end of her strike, and since then there's been little information explaining how she managed to survive such a long hunger strike, as well as what effects the strike could have on her long-term health; she was reportedly turned away from an ashram where she wanted to live post-strike because of their concern that they couldn't offer her proper medical care.

While no food or drink passed her lips over the course of 16 years, Irom still had sustenance. On November 11, 2000six days into her strike—she collapsed and was put on a saline drip. Ten days later, she was affixed with a Ryles tube used to funnel a boiled slurry of rice, lentils, and vegetables—fortified with vitamins, minerals, and medicine—through her nose and directly into her stomach. When Irom would periodically rip the tube out, she was put on an intravenous glucose drip until doctors could convince her to accept the Ryles tube again. The exact composition of her diet shifted constantly, as a medical team monitored her vitals and adjusted their dosages to keep her gastrointestinal health fair, and her weight steady at around 112 pounds.

Irom and her family credit her survival while on this regimen to yoga, which she picked up two years before her strike, and willpower. Medical staff have claimed that she walked outside her eight-by-twelve-foot room and practiced yoga quite skillfully for four hours a day.

Doctors continue to debate the ethics of force-feeding prisoners of conscience on a hunger strike, but based on official media accounts, it's likely that Irom's hunger strike wouldn't have been disastrous to her physical health.

According to Marshall McCue, a St. Mary's University-Texas professor of biology and author of 2012's Comparative Physiology of Fasting, Starvation, and Food Limitation , Sharmila's Ryles tube diet would've maintained her core health and nutrition. Yes, a glucose drip would've had a negative impact on the health-bestowing bacteria residing in her digestive tract—also known as the microbiome—and it would've also decreased her ability to absorb nutrients through traditional digestion after the strike ended.

But McCue told VICE that careful readjustment to the Ryles tube after a few days on the drip wouldn't result in lasting negative effects, adding that a nasal tube was a more humane choice than forced oral feeding. If her weight did indeed hold steady, then she was likely in decent health. "This duration of chronic feed is remarkable," McCue said, further noting that "It would've been possible to continue this [feeding regimen] virtually indefinitely with minimal issues."

One of Irom's doctors, when quoted in a recent (and seemingly critical) Hindustan Times article, went a step further than McCue, arguing that Irom was "getting the healthiest and most balanced of diets that even the richest Indian probably [wasn't] getting" while on the Ryles tube. The article also pointed out that the state, which suffers chronic food shortages and a rising poverty rate , spent at least $150 a month making sure she was consistently fed. While this sounds like a bitter screed, McCue—in measured, diplomatic terms—ultimately agreed that Irom likely received a better balanced, if lower-calorie, diet than many in India or the West.

As long as the tube was correctly inserted, the biggest health concerns Irom likely faces now are atrophy in her jaw muscles—which will fatigue rapidly from chewing until they build back up—and damage to her nasal cartilage from holding up the tube, which also increases her long-term risk of upper respiratory infections. McCue also notes that since her stomach muscles weren't working hard to digest her diet, she'll have to work to digest harder and more varied foods over the coming weeks. He also believes it would be advisable for Irom to stay near medical resources in case of any unlikely unexpected complications.

It's unclear whether Irom will have access to a support system in the recovery process. Although the end of her strike came exactly one month after the Indian Supreme Court struck down absolute legal impunity for armed forces under the AFSPA—triggered in part by cases from Manipur—many of Irom's former supporters have criticized her decision to return to normal life before the Act was struck down entirely. This criticism has been amplified by concerns that a seven-year romantic relationship led her to abandon her principles for personal desire—with activists attacking her purported paramour outside the Imphal courthouse in 2014—as well as the sudden and unexpected announcement of the hunger strike's cessation and the widespread belief that her entry into "dirty" politics will ultimately harm Manipur's cause.

As a result, Irom's been denounced by a number of local groups , one of which ominously noted in a recent statement that activists who enter politics are often assassinated. Her mother's absence on Tuesday has amplified concerns she may be facing estrangement from her family as well. Ultimately, this ill will led locals to turn her away from a neighborhood in Imphal and forced her to seek shelter at the local police station on her first night of freedom.

Some have speculated that Irom may now be forced into short-term exile elsewhere in India, but while she still has strong support as a civil rights icon elsewhere in the nation, one can only speculate how this immediate rejection after years of partial isolation and police custody will weigh on Irom's mental health, as well as how that might interact with her broader recovery efforts.

Despite the fact that she could have theoretically physically sustained her hunger strike indefinitely, ultimately no one knows Irom's mental and physical wellbeing and tolerance as well as she does. With this in mind, although they might not agree with her decision, and at the very least her former supporters might consider cutting her a little slack. It would be a cruel irony if Irom's mental or physical health deterioriated after a 16-year force-feeding regimen, thanks to a new regimen of isolation administered by her old allies.