Global Policy Forum

By Adam Zagorin

The prisoners at Guantanamo Bay, Cuba, won a major victory this week when the Supreme Court struck down the Bush administration's planned military tribunals. But for many prisoners at the detention facility, the protests haven't stopped. Hunger strikes persist, in what Guantanamo commander Rear Adm. Harry Harris, Jr. has called "asymmetric warfare" — a means to attract attention to their increasingly controversial detention. As a result, the camp's administrators have sought to keep prisoners alive at all cost — because a prisoner's death (as the U.S. found out three weeks ago, when three Gitmo inmates committed suicide) can be a major embarrassment for the U.S. and add fuel to widespread demands for the facility to be shut down.

Civil-liberties advocates point out that Guantanamo's 460 inmates have few other means to make their voices heard, given that most have been detained for more than four years without even being charged with a crime. Indeed, though the U.S. has condemned the hunger strikers at Gitmo, just last year the White House hailed a hunger-striking Iranian dissident for showing "that he is willing to die for his right to express his opinion."

At Gitmo, however, dead prisoners are something the U.S. military wishes devoutly to avoid. So force-feeding has been standard policy at the camp ever since hunger strikes began in early 2002. The facility's top physicians have also told TIME that prisoners who resist are subjected to especially harsh methods. In one case, according to medical records obtained by TIME, a 20-year old named Yusuf al-Shehri, jailed since he was 16, was regularly strapped into a specially designed feeding chair that immobilizes the body at the legs, arms, shoulders and head. Then a plastic tube that is 50% larger, and more painful to insert, than the commonly used variety was inserted up through his nose and down his throat, carrying a nutritional formula into his stomach.

Thousands of people, of course, endure some form of voluntary intra-nasal feeding every day in hospital settings. But when force-feeding is involuntary and the recipient is in a state of high anxiety, the muscles tense up and the procedure can trigger nausea, bleeding, diarrhea and vomiting. "We are humane and compassionate,"; Guantanamo commander Harris told TIME, "but if we tell a detainee to do something, we expect the detainee to do it." As a note scrawled in al-Shehri's medical records put it: "[The prisoner] was informed that dying is not permitted."

Before this year, the feeding chair — marketed as a "padded cell on wheels" by its Iowa manfacturer — was evidently used sparingly. In comments several months ago, SOUTHCOM commander Gen. Bantz Craddock, who oversees Gitmo, joked that at least hunger strikers got to choose the color of their feeding tube (yellow was a favorite), and the flavor of the lozenges used to soothe thoats irritated by the feeding tubes. "Look, they get choices," Craddock said at the time. "And that's part of the problem." At the peak of a protest last fall, 131 protesters, or more than 25%, were on hunger strikes.

But in January, say lawyers for the prisoners and other critics of conditions there, camp overseers finally got fed up with protesters undermining camp discipline and overtaxing the medical staff, who often had to spend 15 hours a day feeding obstreperous inmates. Dr. Ronald Sollock, the camp's chief physician, told TIME bluntly that gentler force-feeding techniques of the past were a"failure." He says that without being strapped down, some inmates would try to pull out their nasal tubes, and even strike medical personnel. Worse, some continued to lose weight, by forcing themselves to vomit after being force-fed."We had to take steps to prevent that, but we only do what is medically necessary in a humane and compassionate manner," says Sollock.

The tougher stance on feeding did have an effect on prisoners' willingness to go on hunger strikes."A lot of detainees said, 'I don't want to put up with this. This is too much of a hassle,'" says Craddock. Asked whether the new methods represented an"effective deterrent" to hunger striking, he answered,"Yeah."

Officially, force-feeding at Gitmo is done with a tube 3mm. (or about .1 in.) across, the same size used in American hospitals. In a sworn statement last year, Gitmo's top physician at the time, Dr. John Edmondson, noted that"smaller tubes which remained in the patient for longer periods were more comfortable [and] easier to manage for medical personnel."

Al-Shehri's medical records, however, document the use of the larger tubes, which experts say have no medical purpose in this context. Al-Shehri's lawyer has also filed court documents citing lesions and bleeding caused when guards held him by the chin and hair, strapped down, as a medical staffer"forcefully inserted the tube in his nose and down his throat" The lawyer also charges that al-Sherhri was subject to verbal and religious abuse during force-feeding, asserting that the tubes"were viewed by the detainees as objects of torture." The records also show that instead of leaving the tube in place to avoid the possible trauma of repeated insertions, al-Shehri had his introduced and withdrawn at each of his two daily feedings.

And this leads to another problem. According to al-Shehri's records and Gitmo doctors, a typical feeding lasts about two hours, with the inmate left in the restraint chair for roughly 45 minutes afterward. During the feeding period, the prisoner will receive as much as 1.5 liters of formula, which, in the case of hunger strikers, can be more than their stomachs can comfortably hold. This can produce what is euphemistically called "dumping syndrome," an uncomfortable, even painful bout of nausea, vomiting, bloating, diarrhea, and shortness of breath. And those are precisely the symptoms that al-Shehri and many other force-fed prisoners have reported to their lawyers.

In March, as a result of these allegations, more than 250 medical professionals signed an open letter to the British medical journal The Lancet, demanding an end to force-feeding. They cited the code of ethics of the American Medical Association and the World Medical Association, both of which condemn the force-feeding of prisoners as an assault on human dignity — so long as they're capable of making an informed decision not to eat. But that's the conundrum: How do you know what is an informed decision at Gitmo? Are detainees there, who are imprisoned in an isolated environment far from their families for an indefinite period, capable of making a rational and autonomous choice to starve themselves?

The code of ethics has been put to the test several times in the past, most notably during the 1980s, when several Irish Republican Army prisoners staged hunger strikes in British prisons. A handful died, and the episode was seen as evidence of Margaret Thatcher's toughness. At Gitmo, however, the death of a prisoner could ignite riots in the Muslim world. In that context, the Pentagon believes that keeping detainees alive at all costs is very much in the nation's security interest.

It's equally in the prisoners' interests to have someone die. According to Col Mike Bumgarner, who oversees the detention camps on a day-to-day basis, several prisoners have told him of a"vision, or a dream — implicitly a message from God — that if three detainees die it will attract enough attention so that they will all get out of Guantanamo." It needn't be by starvation: according to newly declassified docouments, two prisoners, one of whom was al-Shehri, tried to commit suicide on May 18 by swallowing hoarded anti-anxiety medication. Those attempts triggered a search, which in turn led to the most serious rioting in the history of Camp Delta. And on May 29, yet another round of hunger strikes began. It started with 75 prisoners, rose to 89 a few days later, and then suddenly began to fade away. Recent communications by Gitmo inmates with their lawyers, and obtained by TIME, indicate that harsh force-feeding methods were used to end the hunger strikes. The military has offered no explanation for the drop-off in hunger strikers.

Bumgarner has said the prisoners' objective is to push the number of strikers above 100, as they did last fall. But additional medical personnel are ready to be shipped in to force-feed them if they do. "We used to over-react, and the detainees saw that we got worried if they were not eating," he says."Now we have a system. I tell them, 'Have at it. If you want to have 460 hunger strikers, we'll get 460 doctors in here to take care of you.' They will not succeed."

Yet hunger strikers have already won a measure of success. In part because of their protests, and the attention focused on Guantanamo, the U.S. is facing growing criticism — from both allies and enemies — for the rules of detention at the camp. Now the Supreme Court's Hamdan decision effectively grants prisoners at least some of their longstanding demands, including more rights at trial. All the same, most of them are unlikely to be released soon. Indeed, authorities are currently constructing a new, state-of-the-art, $30 million prison at Guantanamo, where they plan to consolidate many of the camp's maximum-security inmates. Harris argues the camp will be needed for the forseeable future, and that refusing to eat is not a cry for help, but a ploy drawn from the al-Qaeda playbook calculated to attract media attention and force the U.S. government to back down."The will to resist of these detainees is high,' says Harris."They are waging their war, their jihad against America, and we just have to stop them."