In H Unit, human contact came at the cost of humiliation. In an affidavit, one of Salameh’s codefendants, Nidal Ayyad, said that some men on the unit would put their faces in the toilet and try to talk through the plumbing. “Putting my face in the toilet in order to try to talk with someone is something I’m not willing to do,” he wrote. The men could go years without being touched by someone other than a guard. Besides the rare phone call and visit, months would pass by before they exchanged more than a few words with another person. “How am I supposed to live without speaking to another human being?” another former H Unit inmate, Uzair Paracha, asked me during a phone call.

The harms of solitary are well documented. Studies have shown long-term isolation can lead to paranoia, hallucinations, hypersensitivity to stimuli, and suicide attempts; in 2011, a UN official called for prohibition of the practice in excess of 15 days. According to a lawsuit filed in 2012 and settled in 2016, men at the ADX grew so psychologically unstable from being alone that they smeared feces onto open wounds and swallowed razor blades.

Most prisoners at the ADX—those without SAMs—face fewer constraints on writing letters, accessing news, or communicating with others. The additional layers of isolation weighed on the men. Salameh was granted permission to read USA Today, but for his first few years in H Unit, he could read papers no fewer than 30 days old. The ADX was allowed to take 60 business days to mail out a letter in Arabic and 60 days to process an incoming one, so if Salameh wrote to his mother in Jordan in January, he might not hear back before July. He was prohibited from writing directly to prospective attorneys or legal clinics, making it difficult, though not impossible, for him to fight his conditions in court. In a rare victory in 2014, a federal judge ruled that the DOJ violated a SAMs prisoner’s First Amendment rights in “arbitrarily and capriciously” limiting contact with family and friends. According to attorney Paul Wolf, who fought the case, the ruling helped his client but did not affect conditions in H Unit more broadly.

Salameh’s family went to visit him at ADX just once, in 2012, the year after his father died. His mother came with one of his sisters, whom he hadn’t seen since she was a child. At the time of the visit, she was an adult with a family. When I asked him to tell me about it, he sighed, and when he began to speak, his voice trembled. It was the only time he became emotional during an interview.

Each year around the middle of March, Salameh received a letter stating that his SAMs had been renewed. Despite minor adjustments to the restrictions, there never seemed to be a clear way to get them removed. He filed hundreds of requests and approached guards informally, asking them to intervene. “I received the Special Administrative Measures (SAMs) extension for the third time without any due process or any hearing by [a] Disinterested Committee,” he wrote in an administrative remedy dated July 2007. “These SAMs restrictions are unjustified, unfair, illegal, inhumane, oppressive [and] unconstitutional.” The BOP’s Central Office responded in October, “You may object to the provisions of the SAMs, but as you were appropriately advised, the Bureau merely informs you of the requirements of the SAMs, and ensures the measures are followed,” adding that they would remain in place “until the Attorney General determines it is no longer necessary.”

The men in H Unit were alive, but what did that mean when their connection to the outside world was so tenuous? “Sometimes the unit feels like a graveyard,” wrote Salameh’s codefendant Ayyad in an affidavit. “There is no sound and everyone is in his grave [cell].” Some inmates believed they would be on the measures until they died.

Salameh developed a pattern of behavior. He would go on hunger strike for a while, get force-fed, stop, and recuperate. Then, he’d start all over again. After the 2005 strike, he stopped demanding that the SAMs be lifted entirely, asking only for increased outside recreation time and permission to make two phones calls per month. In 2006 he went on hunger strike for 72 days and was force-fed about 35 times, he said. He also went on hunger strikes in 2007, 2008, 2009, and 2010.

Affidavits from current and former inmates indicate that others have fallen into a similar routine. Two individuals told me another former H Unit inmate, Eyad Ismoil, was force-fed more than 400 times during his time there.

John Moore/Getty Images

Salameh conveyed his determination to keep protesting with a line from a poem he translated from Arabic: “Make me drink the bitter cup, but with dignity.” Salameh accepted that he would die in prison; wasn’t that enough?

Force-feedings occur in other US prisons, too, though it’s unclear how often and where. State facilities have maintained the practice for decades, and over the past few months, The New York Times reported that detainees in ICE custody were force-fed after refusing to eat in protest of their indefinite detention. Just like the BOP, ICE and state prison systems have hunger-strike policies in place guiding how and when the procedure—which they term “involuntary feeding”—should be conducted. Yet experts believe that force-feedings in the H Unit may surpass those at any other.

Robert Hood, now a national-security consultant, was the warden at the ADX from 2002 to 2005, including when Salameh arrived at the facility. During Hood’s more than 20 years working for the BOP, he worked at nine institutions and served as a warden or associate warden at four. He said there were more hunger strikes at the ADX than at other BOP institutions and that those strikes tended to last longer than elsewhere. “To my knowledge, most involuntary feedings at the supermax would have occurred on an H Unit setting,” he said over the phone. When I asked the BOP for data on force-feeding across its facilities, a FOIA officer insisted no such data was kept. However, CBS News reported that as many as 900 “involuntary feedings” were performed on H Unit residents from 2001 to 2007. The BOP did not dispute this finding.

While the men in H Unit were prohibited from speaking to one another, they always figured out when someone else had started a hunger strike. The biggest one Salameh took part in occurred in 2009, when about 10 of 12 H Unit prisoners participated, according to two men who were there. It started after Barack Obama’s inauguration, when a prisoner on the unit requested a copy of his memoir The Audacity of Hope, along with some Islamic texts. The books were denied on national-security grounds. Within a few weeks, Salameh told me, that individual and two others were on hunger strike. Soon, the strike grew.

Salameh didn’t join in immediately; he was still recovering from his last attempt. But he understood the impulse. He’d been denied many books, including a copy of the 2008 CIA World Factbook. “We were in the worst situation that the BOP could offer,” said Uzair Paracha, another participant. “Things couldn’t get worse for us, and they were not willing to let them get better.”

On May 5, Salameh was ready for another try. He knew what to expect: The first 24 hours would be bearable, until the pain in his stomach began. By the fifth day, he could hardly take it. After a week, his body would adjust. Still, he would grow progressively weaker until all he could do was rest; when he’d stand up, darkness and light would flutter across his vision.

The Bureau of Prisons considers someone to be on hunger strike after they refuse meals for 72 hours. Once it becomes official, many of the prisoner’s personal belongings are taken, and the medical checkups start. Three times a week, a five-person force team amassed in front of Salameh’s cell, along with a lieutenant, a physician’s assistant, two guards with cameras, and another carrying gear. A member of the force team would then say, “Inmate Salameh, are you willing to submit to the restraints?” If he had the strength, Salameh would walk to the door to be shackled. Then, it was off to the medical observation room—and perhaps, if the medical staff decided it was necessary, the force-feeding chair.

Salameh said the force-feedings in H Unit followed a routine. First, the guards moved him to a black chair. They secured straps around his shins, thighs, and knees and diagonally across his torso to form an X. His wrists were handcuffed behind his back during the feeding, which sometimes lasted hours. Once he was strapped in, the PA would approach with a nasogastric tube, measure it, and insert it into Salameh’s nostril, attempting to guide it into his stomach, which was always very painful. On some days, the tube would come out of Salameh’s mouth. “Many, many times,” he said, it would enter his windpipe, and he would start “coughing like someone is choking [me] to death” from the inside. (These episodes cannot be corroborated, as they are not noted in his medical records, which are generally sparse.) By the time he left H Unit, his force-feedings tended to occur much later in the course of his strikes, and less frequently.

Force-feeding is dangerous. In hunger strikes as early as 1917 and as recently as 1992, prisoners died as a result. The cause of death was usually from the tube being placed into the striker’s trachea instead of the esophagus, so the liquid entered the lungs rather than the stomach, causing the person to suffocate or develop pneumonia. Other complications include abrasions to the nasal tissue, throat, esophagus, or lungs. The more frequently the procedure is conducted and the more the prisoner resists it, the greater the risks. In order to ensure Salameh did not die in his care, once the PA believed the tube was in place, he blew air into it using a syringe and listened to Salameh’s belly. Then he would start dripping the liquid meal into the tube.

One of the most brutal force-feedings Salameh recalls was on March 20, 2006. As the Novasource, the nutritional supplement, trickled into his body, he tightened his stomach and intentionally caused himself to vomit. The PA put a bowl on his lap so the liquid wouldn’t spill onto the floor but did not stop the procedure. After Salameh vomited the first carton of Novasource, the PA poured a second one into the tube, which Salameh vomited again. At first, he vomited intentionally, but then he lost control. “I wished at that time that I can stop, but I couldn’t,” he recalled. Every time the bowl got full, the PA took it and poured the vomit into the toilet, then continued his work.

According to his medical records, Salameh stared into the camera that was recording the procedure. “Captain, this is for you,” he said. Then he addressed the PA. “The lion does not want to be fed. I will do the same tomorrow if you try to feed me.” (All use-of-force episodes are videotaped and reviewed by senior management. I requested copies of Salameh’s tapes from the BOP and will be challenging the FOIA denial in court.)

Over the course of 90 minutes, the PA attempted to feed Salameh 16 cartons of Novasource, about a gallon of the liquid, only to have him vomit up each one. About a week later, after several other feedings, Salameh experienced flu-like symptoms and ran a fever—a sign of possible aspiration, which can lead to pneumonia. He was prescribed antibiotics, and the symptoms subsided. Another former H Unit inmate described a similar incident in which he was overfed to the point of becoming ill.

After every force-feeding, the men were taken to an empty observation room, where they waited, sometimes for hours, before being allowed to return to their cells. Unlike at Guantánamo, the medical staff at the ADX would conduct daytime feedings during Ramadan, according to Salameh—a policy that he said was designed to “break [us] down.” Crosby, the Boston University force-feeding expert, reviewed Salameh’s records at my request and said there was no medical rationale behind them. “In my opinion, putting 16 cans of Ensure or some kind of nutritional supplement would not only be clinically inappropriate but, it seems to me, with an intent to punish or to cause physical discomfort.”

At the very least, according to past statements by UN officials, force-feeding as conducted at the ADX would qualify as cruel, inhuman and degrading treatment. “When the circumstances of forced feeding include evidence of an intent to inflict pain and suffering for a purpose like punishment, intimidation, or coercion, forced feeding becomes torture,” said Margaret L. Satterthwaite, who teaches international law at New York University. Salameh once told me he would have preferred to be waterboarded rather than force-fed, because the public understands that waterboarding is a form of torture. Force-feeding was done under the guise of benevolence, while its true intent was something far more sinister. “Ask why they torture us. They don’t want to save your life. They want to pressure you to stop your hunger strike.”

In March 2015, Salameh’s SAMS renewal notification arrived, citing his previous hunger strikes as evidence of his “extremist and violent views.” The year before, an FBI agent testified in federal court that the strikes in H Unit constituted an “Al Qaeda conspiracy.”

“That’s baloney,” said Salameh of the allegation. “They are trying to undermine our hunger strike,” to draw attention away from conditions the men were trying to protest, he explained.

The SAMs renewal didn’t stop Salameh from striking again in the fall. After 18 days, he was transferred from H Unit to a medical-observation cell whose walls, he said, were covered in feces. He was force-fed after 34 days and soon resumed eating out of concern the medical staffers weren’t well trained. He didn’t secure his demand for more food rations. “I’m hunger striking for food!” he said, laughing. “It’s funny if you think about it.”

Based on conversations with five former prisoners and a review of medical records, legal documents, and past reporting, from 2005 to 2016, as many as two-thirds of H Unit prisoners participated in hunger strikes. They were collectively force-fed hundreds if not thousands of times. With assistance from lawyers, they won concessions, including more telephone calls, more recreation time, fewer restrictions on outside media, and the ability to conduct no-contact visits unshackled.

But these hunger strikes in H Unit didn’t prompt investigations into conditions there or condemnations from the American Medical Association or calls from elected officials about the need for change. At Guantánamo, said Pardiss Kebriaei, a lawyer with the Center for Constitutional Rights, attorneys could visit their clients on hunger strike, hand their interview notes to government censors, and get some version back that could be released. Not so at the ADX. There “the hunger strike is buried,” said Salameh. “Nobody will know about it…and that helps the government not to give up anything.”

That’s largely because hunger strikers rely on the media to convey their concerns—and the SAMs make that task all but impossible. In 2013 nearly 30,000 people incarcerated in California went on hunger strike to protest long-term isolation. After about two months and extensive media coverage, they secured substantive policy changes. (The state successfully petitioned a court for legal permission to force-feed prisoners, but there is no indication force-feedings later took place.)

‘Ask why they torture us. They don’t want to save your life. They want to pressure you to stop your hunger strike.’ SAMs gag those best equipped to help prisoners speak out, like lawyers and family members. “It was as if from that moment [when the restrictions were imposed], the government decided that he ceased to exist,” said the sister of a former H Unit inmate. “I could talk about him in the past tense but not in the present tense. I could talk about who he was but not who he is.” The SAMs also make reporting about life in H Unit extraordinarily difficult. Nearly all the former H Unit prisoners I spoke to worried our conversations could land them back at the ADX. Salameh was put on communication restrictions for a period during my reporting and suspects it was due to our contact. Former SAMs prisoners are not restricted from speaking about their past, but out of caution, most lawyers opt not to talk about what happened to their clients on SAMs, even after the measures have been lifted—which makes reporting on the prisons even harder. Since 9/11, journalists have been denied entry to the ADX facility almost without exception. Not even the UN special rapporteur on torture has been allowed in. In March 2016, after years of legal challenges from his attorney, Salameh learned his SAMs would not be renewed. The news was a relief: His mental health had started deteriorating, to the extent that he’d asked for psychiatric care. Today he’s at USP Big Sandy, a high-security prison in Kentucky. The trauma of H Unit comes back to him in his dreams. But whatever violence he has endured, and whatever violence he may have caused, life goes on. In November 2017 Salameh’s sister gave birth to twins. When we spoke, he said they were “beautiful babies,” and his voice was full of light. Then came the humor: “I was thinking maybe they can name one of them…after me, but they already named them.” As the time for the publication of this article neared, Salameh disclosed he’d been advised to use a pseudonym out of concern he might face retaliation from BOP staff. But he decided to risk it; he said there’s intrinsic value in bringing these long-buried truths to light. “For me, it is history,” he once told me. “It needs to be known.” This article was reported in partnership with Type Investigations, with support from the Fund for Constitutional Government and the Puffin Foundation.

About the reporter Aviva Stahl Aviva Stahl is a Brooklyn-based investigative journalist who writes about the criminal justice system and national security issues.