Chapter 3 Conditions of Detention | 67 “involuntary feeding is used only as a last resort, if necessary to address significant health issues caused by malnutrition and/or dehydration.” 164 144. According to revised standard operating procedures for hunger striking prisoners in Guantanamo, dated March 5, 2013, decisions to force-feed a detainee must be approved by the JTF-GTMO commander, who must notify the chain of command all the way to the Department of Defense. Further, according to these procedures “[i]n event of a mass hunger strike, isolating hunger striking patients from each other is vital to prevent them from achieving solidarity.” 165 Forced feedings, which in some cases may require restraints, are carried out through the insertion of nasogastric tubes into the patient’s stomach. The detainee may remain in a restraint chair for up to two hours. 145. In a public hearing before the IACHR, Omar Farah, an attorney with the Center for Constitutional Rights representing prisoner Tariq Ba Odah, stated “as we speak, it’s likely that he’s being removed from his cell, strapped to a restraint chair, and a rubber tube is being inserted into his nose to pump a liquid dietary supplement into his stomach. Tariq says this is the only way that he has to communicate to those of us who have our freedom what it means to be unjustly detained, to be put in a cell for a decade without charge.” 166 Forced feeding is considered a very painful procedure, in particular when it is not voluntary. Adnan Farhan Abdul Latif, who was on hunger strike during several months in 2006-2007, described the forced feeding as “having a dagger shoved down your throat.” 167 146. The Inter-American Commission notes that hunger strikes are a well-known form of protest. The vast majority of the detainees who went on hunger strike in Guantanamo were protesting their state of indefinite detention and their conditions of confinement. Making a blanket determination that all the individuals on hunger strike have suicidal intentions and therefore must be force-fed is not in line with medical ethics requirements. The State has an obligation to make an individualized assessment to determine whether the individual detainee actually possesses the capacity to make a judgment about the physical consequences of refusing food. If the individual understands those consequences, the right to refuse food should be respected both under medical ethics and international law. According to Dr. Xenakis, conversations concerning end of life issues should be held upfront, with 164 165 166 167 Submission of the Government of the United States to the Inter-American Commission on Human Rights with respect to the Draft Report on the Closure of Guantanamo, OEA/Ser.L/V.II.Doc. 30 January 2015, March 30, 2015, p. 8. Joint Task Force Guantanamo Bay, Cuba, Joint Medical Group, Standard Operating Procedure: Medical Management of Detainees on Hunger Strike, SOP: JTF-JMG # 001, March 5, 2013. Available at: http://humanrights.ucdavis.edu/projects/the-guantanamo-testimonials-project/testimonies/testimonies-ofstandard-operating-procedures/hungerstrike_sop_2013.pdf IACHR’s hearing, Situation of the Detainees in Guantanamo, 147 Period of Sessions of the IACHR, March 12, 2013. IACHR’s Expert Meeting on the situation of detainees held at the U.S. Naval Base at Guantanamo Bay, Washington DC, October 3, 2013. See also, Poems from Guantanamo, Amnesty International Magazine, Fall 2007, by Mark Falcoff. Available at: http://humanrights.ucdavis.edu/projects/the-guantanamo-testimonialsproject/testimonies/prisoner-testimonies/poems-from-guantanamo Inter-American Commission on Human Rights | IACHR