Guantanamo Bay, Cuba - A military physician who oversees a team of nurses force-feeding hunger-striking prisoners at the Guantanamo Bay detention facility has dismissed ethical concerns raised by human rights groups and medical organisations about the procedure, saying the medical community was motivated to speak out about the practice for political reasons.

In an interview with Al Jazeera at the prison's detention hospital last week, the physician, who, for security reasons, could only be identified as a senior medical officer of the Joint Medical Group, was defensive when pressed about questions regarding medical ethics and force-feeding.

"It's very easy for folks outside of this place to make policies and decisions they think they would implement," the senior medical officer said. "This is kind of a tough mission and this is kind of an ugly place sometimes, alright? The reality is when faced with people who are hunger striking, potentially to the point of needing medical intervention to protect their life and to keep them from harming themselves, suddenly it's not a very abstract decision. Hunger strikes are tough and a big use of time. I realise there's a lot of controversy. But it's a political thing."

Thirty of the 103 Guantanamo prisoners who have been on hunger strike since February are now being fed a nutritional supplement through a tube that is threaded through their nostril and into their stomach, a brutal procedure laid bare in an exclusive report last week by Al Jazeera, citing the military's own standard operating procedure (SOP), which was written March 5, a month after the hunger strike started.

The practice has been criticised by the president of the American Medical Association (AMA), who said in a letter sent to Secretary of Defence Chuck Hagel in April that force-feeding "violates core ethical values of the medical profession" and "every competent patient has the right to refuse medical intervention, including life-sustaining interventions".

Key changes in protocol

The American Civil Liberties Union (ACLU) noted that the newly revised hunger strike and force-feeding protocol obtained by Al Jazeera "makes a few key changes" from a previous version issued in 2005.

"Critically, the chief medical officer in Guantanamo no longer makes the final call as to who is labeled a hunger striker," according to the ACLU's analysis of the two documents. "Now, the military commander of the base - who is not a doctor - makes that determination. Deleted is the 2005 SOP's language directing military personnel to make 'every effort … to allow detainees to remain autonomous' up to the point the military believes force-feeding is necessary. The current SOP does not mention autonomy even once. Whereas the 2005 version required personnel to 'make every effort to convince the detainee to accept treatment,' the current SOP only requires 'reasonable efforts.'"

Last week, after Al Jazeera published the SOP, the ACLU and 19 other human rights groups sent a letter to Hagel urging him to "intervene to end the force-feeding of competent hunger-striking prisoners in Guantanamo Bay, which constitutes cruel, inhuman, and degrading treatment".

During a Pentagon news briefing last Friday, in response to a question from a reporter, Hagel said that the US has an "ethical responsibility to assure the health and well-being of every detainee and we're certainly doing everything we can to do that".

Overnight medical stay area inside the Guantanamo Bay prison where detainees receive medical care [Army Sgt. Brian Godette]



"We're doing everything we can to protect those detainees and we do need a resolution to this," Hagel said, referring to closing the prison. "The president has said that he's working toward it."

President Obama is expected to give a major speech on his counterterrorism policies on Thursday, which will include a discussion about Guantanamo, where 86 prisoners have been cleared for transfer or repatriation to their home and other countries for years.

Prisoners 'choosing this behaviour'

The senior medical officer said he "can't speak to what the AMA opposes or doesn't oppose".

"There's lots of politics involved and I'm sure they have internal politics that they need to answer to as well," he said. "The policy and mission of our medical team is to keep these folks as healthy as possible."

"One way of thinking of this is that it's not much different than a patient causing self-harm," he said. "If a patient is threatening to hurt themselves or kill themselves we're not going to stand by and watch that happen. This is a detention facility. We're following US legal precedence for how you manage hunger strikes. [The prisoners] are choosing this behavior."

Contradicting the prisoners' attorneys who said their clients have told them they were determined to strike "to the death", the senior medical officer asserted the prisoners have, "almost unanimously", requested medical intervention to keep them alive.

"These folks that are on the hunger striking list have asked that when it comes time … if I were to become incompetent or unconscious that they would want medical to support their health," the senior medical officer said. "That's been my personal experience. The majority of them, when push comes to shove, they're asking to be fed. They're asking for the feed and they're given many opportunities to avoid this process. The majority at this point are electing to choose it."

"In fact, many of the detainees have thanked the physicians and the medical teams for the support that we give them to keep them healthy during their protest," he added.

Some prisoners who have refused food have complained of stomach distension and discomfort, the senior medical officer said, adding that he is starting to see the "chronic effects of malnutrition", which includes being underweight, muscle wasting, and organ failure. Attorneys for the prisoners have said their clients have lost 14-18 kilograms since the start of the protest.

The senior medical officer said prisoners have been coerced into participating in the hunger strike and have sought relief in the detainee hospital because it is the only place they can safely eat, even if it is through a tube.

"Detainees have asked to come to the detention hospital to be enternally fed because they're not allowed to eat on the blocks" in sight of other detainees, the senior medical officer said. In the detention hospital, "they can get out of the public view of each other and come here and be offered meals [and] can eat by themselves".

Carlos Warner, a federal public defender who represents Kuwaiti prisoner Fayiz al-Kandari and 11 other prisoners, lashed out at the senior medical officer, stating his "license to practice medicine is in jeopardy".

"Force-feeding against the will of a competent patient is a clear violation of medical ethics," Warner told Al Jazeera. "The United Nations has called it torture. This physician has no choice but to claim the men are being voluntarily fed. The physician is preparing for the inevitable disciplinary proceedings that will be prosecuted when he returns to the United States. And rest assured, these cases will be prosecuted as many of us are resolute in pursuing claims against doctors who torture our clients."

No pain

Numerous prisoners have said in letters they turned over to their attorneys that the force-feeding procedure, in which a 61 cm tube or longer is shoved up their nostril and down into their stomach, is excruciating and dehumanising.

"I will never forget the first time they passed the feeding tube up my nose. I can't describe how painful it is to be force-fed this way," wrote hunger striker Samir Naji al-Hasan Moqbel, in a widely read New York Times op-ed published April 14.

Protests against the Guantanamo Bay prison continue around the world [EPA]

"As it was thrust in, it made me feel like throwing up. I wanted to vomit, but I couldn't. There was agony in my chest, throat and stomach. I had never experienced such pain before. I would not wish this cruel punishment upon anyone."

Other prisoners have written letters describing similar experiences with being tube-fed. But the officer in charge of the detention hospital, who goes by the fake name of Leonato, adopted from William Shakespeare's play "Much Ado About Nothing", told Al Jazeera and other visiting journalist he "hasn't seen anybody in pain".

"Nobody has expressed to me, ‘this hurts,'" said Leonato, who is also a registered nurse. "I don't do all of the [force-feeding] procedures. Just the ones here at the hospital. I've actually had patients help me and guide me and tell me what to do as far as dropping the tube."

No end in sight

UK-based human rights organisation, Reprieve, sent a letter May 14 to the chairman and chief executive of Abbott Laboratories, the manufacturers of the nutritional supplement Ensure, which has become symbolic with the force-feeding procedure at Guantanamo. The letter called on Abbott to "explicitly disassociate your product line from any use in force-feeding detainees at Guantanamo".

A spokesman for Abbott Laboratories did not return calls or emails for comment.

Navy Captain Robert Durand, a Guantanamo spokesman, told Al Jazeera last week that military officials have no intention of negotiating with the prisoners to end the hunger strike.

The senior medical officer added, "We're fully prepared to continue this for as long as we have to".

Follow Jason Leopold on Twitter: @JasonLeopold