A hunger for rights
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.
'... Only when it reached my stomach could I resume breathing, carefully. Then [the doctor] 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.'
Soviet dissident Vladimir Bukovsky wrote this in a Washington Post article that brings home the horror of institutionalised force-feeding. Bukovsky spent almost 12 years in Soviet prisons where he was regularly force-fed after going on hunger strikes.
Mr Bukovsky and other activists worldwide have been outraged that hunger-striking detainees at the Guantanamo Bay facility in Cuba have been subjected to this controversial procedure. The US military denies that its force-feeding of inmates at Guantanamo is like the torture described by Mr Bukovsky.
'Force-feeding is a misleading term,' said Lieutenant-Colonel Jeremy 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 are not sedated during tube-feeding, but are given a mild local anaesthetic if requested. Detainees are sitting upright when tube-feeding occurs, and the process lasts one to two hours. DoD [Department of Defence] 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 in November last year, 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.'
This public washing of hands may make Mr Rumsfeld appear untouchable for what some people would consider 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 Guantanamo, have filed court action in California, asking the judiciary to look into the ethical liability of Captain John Edmondson, the former 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.
Military health-care providers are 'screened' before deployment to Guantanamo 'to ensure they do not have ethical objections to assisted feeding', Captain Edmondson told Susan Okie, MD, who wrote about her visit to Guantanamo in December's issue of the New England Journal of Medicine.
But, according to Nepalese doctor Bhogendra Sharma, international programme adviser of the Medical Foundation for the Care of Victims of Torture, the practice is unethical. 'It is the duty of doctors to respect the autonomy of a patient.'
To carry out any sort of procedure, he said, the doctor needed the 'informed consent of his patient'.
In his sworn affidavit, viewed by the South China Morning Post, Captain Edmondson said: 'The actual feeding process ... is very voluntary. Detainees retain a large measure of control over the administration of the nutrition. ... The detainee himself controls the flow of the nutrition so that any discomfort is minimised ... The detainees within their cells come voluntarily to the door and hand their naso-gastric tube out to a nurse.'
The nurse attaches a feeding bag and hangs it outside the cell. 'The length of the tube allows the detainee to move about within his cell for the two hours of feeding.'
Dr Sharma was puzzled as to why detainees willing to receive nutrition didn't just eat instead of going through the discomfort of tube-feeding.
Dr Sharma, like many other activists, believes tube-feeding is a form of torture. 'Force-feeding is very painful. It can be used as a form of coercion.'
Recent reports of abuse suffered by prisoners at the hands of the US military have hurt America's image.
No prisoner has died at Guantanamo Bay. The officers are proud of this record and aim to keep it that way. Activist and British neurologist David Nicholl said he believed it was this very record which was helping motivate the medical staff to cross the ethical boundaries. 'It's a face-saving effort.'
On January 11, Captain Edmondson was transferred from Guantanamo to become head of the future operations division of the Bureau of Medicine and Surgery. In a move that raised eyebrows among activists, he was awarded his third Legion of Merit medal.
'Your current actions are in direct contravention of internationally agreed legal and ethical standards that have been ratified by the American Medical Association ... In the UK, we stopped force-feeding inmates 100 years ago ... as the practice was felt to be barbaric then, it still is,' Dr Nicholl wrote in a letter to Captain Edmondson.
The British government faced this dilemma during its incarceration of Irish Republican Army members and allowed them to starve to death, he told the Post.
Captain Edmonson replied: 'You have a responsibility to base your conclusion on facts. Not on the accusations levelled in the media and broadcast by defence attorneys who are more interested in publicity than in the rights or health of their clients. I'm 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 access. The only non-partisan organisation allowed unfettered access to the detainees and facilities at Guantanamo Bay is the International Committee of the Red Cross (ICRC), and it does not make public its reports for fear of losing this right. '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 confidentiality is not what it's actually about,' ICRC president Jakob Kellenberger said 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.
Guantanamo Bay remains a festering sore on the face of human rights, under the auspices of the nation that styles itself as the paragon of those rights.
And Bukovsky's words ring true. 'Think what effect your attitude has on the rest of the world, particularly countries where torture is common, such as Russia. [President Vladimir] Putin will be the first to say: 'Even your vaunted American democracy cannot defend itself without resorting to torture'.'
