What is A Hunger Strike

What is a Hunger Strike?

Hunger strikes in prison are dangerous for both prisoners and jailers, but they are often the only way, or the last resort, for prisoners to protest the conditions of their confinement. Hunger strikes in prison can result in death when the government refuses to either negotiate or force-feed; this happened to members of the Irish Republican Army who went on a hunger strike in the Maze Prison in the early 1980s and to hunger strikers in Turkish prisons in 1996 and from 2000 to 2003.14

Hernan Reyes of the International Committee of the Red Cross has written the most authoritative article on hunger strikes, which he also terms "voluntary total fasting."15 According to Reyes, fasting, voluntariness, and a stated purpose are all needed before a prisoner can be said to be on a hunger strike. Simply refusing to eat as a reaction to a specific situation, whether in frustration or anger, for example, does not qualify as a hunger strike. Thus, the initial rounds of fasting at Guantanamo in early 2002 in response to specific actions of the guards toward individual prisoners do not count.6 Nor do prisoners who refuse to eat as a result of severe depression or other mental illness, and with no goal in mind other than their own death, qualify as legitimate hunger strikers.

The determination to fast until either political demands are met or death occurs may vary from person to person. This is especially true when fasting occurs in groups, since members of the group may be less free to break the fast; peer pressure must be taken into account by physicians when deciding whether prisoner-patient is voluntarily continuing to refuse food.14,15 The determination of the hunger striker will also suggest the likely medical consequences of continuing the hunger strike. Most hunger strikers, for example, have taken some water, salt, sugar, and vitamin B1 at least for a time before asserting an intention to fast to death.14 Physicians should inform hunger strikers that intake of these nutrients considerably decreases the chances of permanent disability should the strike end before death (which is never the desired end point of a true hunger striker).

In its Declaration of Tokyo, the World Medical Association ruled out physician participation in the force-feeding of prisoners. Nonetheless, its more specific Declaration of Malta (Declaration on Hunger Strikers) permits physicians to attend to a prison hunger striker in the context of a traditional physician–patient relationship if consent and confidentiality can be maintained. As compared with the International Committee of the Red Cross's definition, the World Medical Association's definition of a hunger striker is much broader in that it does not require a specific goal: "A hunger striker is a mentally competent person who has indicated that he has decided to embark on a hunger strike and has refused to take food and/or fluids for a significant interval."16

Health Law, Ethics, and Human Rights

Volume 355:1377-1382 September 28, 2006 Number 13


Hunger Strikes at Guantanamo — Medical Ethics and Human Rights in a "Legal Black Hole"
George J. Annas, J.D., M.P.H