The ICRC's role and key working principles
Hunger strikes are not a new form of protest, but since 2012, a number of Palestinian prisoners in Israel and, as of 2015, in the occupied Palestinian territory increasingly turned to hunger strikes to protest their detention or conditions of detention. While the ICRC does not judge the reasons and choices for such forms of protest, just as it does not generally take position on the reasons for which people are detained, as a humanitarian organization, it follows up very closely on hunger strikers' health condition and well-being.
At all times, the ICRC seeks to ensure that the rights of detainees on hunger strike and their dignity and physical integrity as patients are respected, and that the treatment they receive and the conditions in which they are held are humane and meet international standards. It also reminds the authorities of the importance of family visits, and ICRC colleagues stay in close contact with families throughout a hunger strike, to ensure they are kept updated about their loved ones' situation.
Crucially, as a neutral organization, the ICRC cannot advocate for the end of a hunger strike, nor for the concerned authorities to agree with the striker's demands. It however encourages the patient, their representatives and the respective authorities involved to keep communicating and exchanging in order to find a solution that will avoid any loss of life.
The Q&A below offers a recap of the ICRC's role in this regard, both during individual and collective hunger strikes, and the key principles underpinning its work.
What can the ICRC do when detainees go on hunger strike?
When the ICRC visits an Israeli or Palestinian place of detention where a hunger strike is in progress, it carefully assesses the situation to understand the issue(s) at stake through private meetings with the detainees, and discussions with the prison managers, custodial staff and health staff involved. The ICRC neither judges the merits or legitimacy of hunger strikes as a means of protest, nor does not take part in the negotiations between the authorities and the detainees on hunger strike.
While urging both the detaining authority and the detainee to find a solution, the ICRC strives to ensure that the rights and physical and psychological integrity of detainees on hunger strike are respected including the choice to continue or abandon the hunger strike- and that proper care and treatment is provided to them with their consent.
The ICRC will continue to visit detainees on hunger strike regularly, to assess their health condition and the medical attention provided by the hospital and by detaining authorities. ICRC delegates also stay in regular contact with the concerned detainees' families, delivering "Salamats" (verbal greetings) and keeping them well informed about the evolution of their loved ones' health condition.
What is the role of an ICRC medical doctor during a visit to detainees on hunger strike?
ICRC physicians have a specific and crucial role to play: to assess the hunger strikers' medical condition, and to ensure that they are refusing food voluntarily and in full knowledge of the possible consequences of fasting on health and life. The ICRC doctor also attempts to make sure the hunger strikers are not suffering from mental illness, for if they were, that would call into question the strikers' capacity to make a voluntary and fully informed choice to refuse nourishment. In addition, the ICRC physician monitors the medical condition of the detainees involved, and the care that they receive. Through dialogue with health staff managing the hunger strikers, the ICRC physician aims to ensure that the medical care being provided meets current technical and ethical standards, especially regarding critical health issues known to arise from prolonged fasting or, should a hunger striker choose to stop his protest, from resuming nourishment after a prolonged fast. In particular, the ICRC doctor aims to ensure that medical staff are not involved in "forced feeding" of inmates, which would constitute a gross violation of medical ethics.
The visit of an ICRC physician to a detainee on hunger strike does not substitute the role of the treating physician, who undertakes the delivery and coordination of comprehensive care for patients. Moreover, such visits should not impact the ability of the detainee to receive independent medical visits. ICRC visits must not have the effect of depriving detainees of the benefits to which they are entitled under IHL, or from exercising their rights under other relevant bodies of law.
In Israel and the occupied Palestinian territory, two ICRC physicians carry out visits to Israeli or Palestinian places of detention, and closely monitor any detainee on hunger strike, offering them independent and confidential medical advice. If deemed necessary, for instance during mass and prolonged hunger strikes, the ICRC may also call on its headquarters for additional support to follow up individually on each hunger striker.
What is the ICRC's position on the forced feeding or forced treatment of detainees?
The ICRC is opposed to force feeding or any treatment which goes against a patient's wishes because it is essential that detainees' choices be respected at all times and their dignity preserved. Forced feeding of hunger strikers is never ethically acceptable. It is furthermore a violation of internationally accepted medical ethics and may lead to violations of international humanitarian law.
In its opposition to the forced feeding of hunger strikers, the ICRC bases its decision on policies approved by the World Medical Association in the Declaration of Tokyo (1975) and the WMA Malta Declaration as revised in 2006. The latter states: "Where a prisoner refuses nourishment and is considered by the doctor as capable of forming an unimpaired and rational judgement concerning the consequences of such voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of the prisoner to form such a judgement should be confirmed by at least one other independent doctor. The consequences of the refusal of nourishment shall be explained by the doctor to the prisoner."
The ICRC position will always be to consider the detainee's freely made choices and the preservation of their human dignity as key criteria for such choices.
More about the ICRC's role during a hunger strike: