Officials at the Guantanamo Bay detention facility have come up with an ingeniously misleading new term to describe hunger strikes at the prison: “long-term non-religious fasts.”
The rebranding appears in a 24-page document with the equally ingeniously misleading title, “Medical Management of Detainees With Weight Loss.” The standard operating procedure (SOP) document was exclusively obtained by VICE News Monday afternoon in response to a Freedom of Information Act lawsuit.
"Preventing [redacted] is important to maintaining good order and discipline in the detention environment, and in protecting detainee health," the document says. "The procedures outlined in this SOP will be protected from release to detainees and other personnel, including [Joint Task Force (JTF)] staff and visitors without a need to know."
The document advises Guantanamo’s Joint Medical Group (JMG) on how to treat prisoners who engage in hunger strikes (a.k.a. long-term non-religious fasts). The SOP was implemented this past December, which was also when Gitmo public-affairs officers stopped providing the media with daily statistics on the number of prisoners who were engaged in hunger strikes and being subjected to force-feedings.
“In the event a detainee refrains from eating or drinking to the point where it is determined by medical assessment that continued fasting will result in a threat to his life or seriously jeopardize his health**,** JMG medical personnel will make reasonable efforts to obtain voluntary consent for medical treatment,” the protocol states. “If consent cannot be obtained from the detainee, medical procedures necessary to preserve health and life shall be implemented without his consent…. When involuntary feeding/fluid hydration is medically required, the JMG Senior Medical Officer (SMO) will inform the JMG Commander. When the SMO and JMG Commander reach concurrence, they will inform the JTF Commander and request written approval to administer involuntary feeding/fluid hydration.”
Previous military documents relating to Guantanamo prisoners and the force feeding program had used the term hunger strike liberally. This SOP, however, doesn't use the term once.
The document says the "medical management of detainees with weight loss in GTMO has evolved over time." However, it contains redactions that appear to obfuscate what, exactly, is considered "clinically significant weight loss," and how exactly that's calculated. The document notes that, "Effective management of detainees with weight loss requires a close partnership between the JMG medical staff and the Joint Detention Group (JDG) guard force."
Retired Army Brigadier General Stephen Xenakis, who has consulted on numerous Guantanamo prisoner cases, said it’s clear that the new SOP is a hunger-strike protocol despite the complete absence of the term. “The document tries to give the impression that it’s not about hunger strikes — that it’s about weight loss,” Xenakis told VICE News. “They took the emphasis off of hunger strikes. It’s a disguise.”
Xenakis said he is troubled by the new protocol because it shows that Guantanamo medical personnel are not complying with the World Medical Association’s (WMA) recommended procedures on how to deal with hunger-striking prisoners.
“There is nothing in there about respecting voluntary consent to refuse food,” Xenakis said. “They [Guantanamo officials] are completely sidestepping WMA’s advice.”
The WMA’s revised protocols say that, “Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially."
Xenakis added that the new protocols do not address the speed at which a prisoner is forced to ingest a liquid nutritional supplement, such as Ensure, through a nasogastric tube.
“It’s very important in terms of addressing the pain and suffering of a detainee and side effects," he said. "You always have to worry if you do these nasogastric tube feedings too quickly — the person will vomit.” The American Civil Liberties Union noted in an April 2009 letter to then Secretary of Defense Robert Gates that the "debilitating risks of force-feeding include major infections, pneumonia, and collapsed lungs."
This SOP marked the third time hunger-strike protocols at Guantanamo were changed in 2013. A policy implemented in March, during the height of a mass hunger strike, was changed in November and again in December. Why was the March policy changed twice? Perhaps because it was roundly condemned by human rights organizations, which said the protocols rose to the level of torture. The March document revealed that prisoners were required to wear masks over their mouths while they sat shackled in a restraint chair for as long as two hours with a tube snaked down a nostril.
The existence of a new hunger-strike policy was revealed last November in a footnote in a letter the Justice Department sent to attorneys who sued the government, challenging the legality of the force feedings. The Justice Department letter said only that the new policy was implemented to “better focus on the adverse health effects of clinically significant weight loss on each individual detainee.”
The SOP document turned over to VICE News today contains entire pages that are redacted. The introduction advises medical personnel what the protocol is for beginning force feeding, which is described as “enteral feeding." But the SOP does not contain a description of the restraint-chair protocol that was described in vivid detail in the March document. Military officials have indicated that there is now a separate standard operating procedure governing the use of restraint chairs.
David Remes, an attorney who represents more than a dozen Guantanamo prisoners, told VICE News that during a recent trip to the prison, he was informed by his clients that there were about 30 prisoners on hunger strike.
In an interview at Guantanamo in December, Cmdr. John Filostrat, director of public affairs for Joint Task Force-Guantanamo, said the military stopped providing the media with the number of prisoners who were engaging in hunger strikes because the prisoners had become too successful at attracting attention to their cause.
“It’s been a self-perpetuating story,” Filostrat said. “It’s (the strikers') desire to draw attention to themselves, and so we’re not going to help them do that.”
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