Navy nurse refuses to force-feed Guantánamo captive

Miami HeraldJuly 16, 2014 

A closer look at the "enteral feeding" display for journalists on Thursday, March 21, 2013 meant to illustrate how Navy medical staff feed hunger-striking captives via a tube up their nose at the U.S. Navy run hospital at the prison camps at Guantanamo Bay, Cuba.

GUANTANAMO -- In the first known rebellion against Guantánamo’s force-feeding policy, a Navy medical officer recently refused to continue managing tube-feedings of prison hunger strikers and was reassigned to “alternative duties.”

A prison camp spokesman, Navy Capt. Tom Gresback, would not provide precise details but said Monday night that the episode had “no impact to medical support operations at the base.”

“There was a recent instance of a medical provider not willing to carry out the enteral feeding of a detainee,” he said in an email. “The matter is in the hands of the individual’s leadership.”

Word of the refusal reached the outside world last week in a call from prisoner Abu Wael Dhiab to attorney Cori Crider of the London-based legal defense group Reprieve. Dhiab, a hunger striker, described how a nurse in the Navy medical corps abruptly refused to “force-feed us” sometime before the Fourth of July — and disappeared from detention center duty.

Crider called the male nurse the first known U.S. military conscience objector of the 18-month-long hunger strike in the prison camps, and said his dissent took “real courage ... none of us should underestimate how hard that has been.”

Dhiab, 43, is challenging Guantánamo force-feeding policy in federal court. A Syrian who was cleared for transfer from Guantánamo in 2010 but who can’t be repatriated because of unrest in his homeland, has been an on-again, off-again hunger striker to protest his indefinite detention.

He’s also one of six detainees that Uruguayan diplomats interviewed at Guantánamo in February and agreed to resettle, according to a U.S. government official, pending U.S. Defense Secretary Chuck Hagel’s approval.

The Herald has not been able to determine the nurse’s name or home base. Crider said Dhiab described the nurse as a perhaps 40-year-old Latino who turned up on the cellblocks in April or May, with the rank of a “captain” — suggesting he has two bars on his uniform.

Guantánamo medical staff come from the Navy, and wear different battle dress that distinguishes them from Army guards on the 2,200-member staff — meaning the nurse is likely a Navy lieutenant.

Last year, civilian doctors decried as unethical the Guantánamo military medical staff’s practice of force-feeding mentally competent hunger strikers in a commentary in the New England Journal of Medicine — and urged a medical mutiny.

Guantánamo currently has 149 detainees, an unknown number of them on hunger strike under a blackout imposed by U.S. Southern Command in December after nine months of daily disclosure. The prison has a 147-member medical staff, “of which 83 are responsible for direct detainee care,” Gresback said.

Asked how many prisoners were on hunger strike and tube fed Monday and Tuesday, he replied that it’s “policy to not address the number of detainees who choose to engage in non-religious fasting or those who would require enteral feeding.”

Retired Army Brig. Gen. Stephen Xenakis, a psychiatrist who visits the prison frequently and considers Guantánamo force-feeding policy to be unethical, said he had no first-hand knowledge of the episode but, based on his talks with Pentagon policymakers, the nurse should suffer no professional setback for having refused to do force-feedings.

Medical staff are allowed to refuse by invoking medical ethics, he said, and should not be treated as insubordinate. Instead, the nurse should be allowed to continue providing health care to detainees, just not enteral feeds.

“They have said to us directly that if a provider objects for ethical reasons or other reasons they would not be ordered to participate — and they would not suffer any adverse consequences,” said Xenakis.

At Southcom, the prison’s higher headquarters, Army Col. Greg Julian said the naval officer who objected to the forced feedings would not be made available for an interview. He also said there had been a previous episode at the prison of a military member who disagreed with a medical order for a detainee that was “dealt with administratively,” but that episode did not involve a hunger-strike tube-feeding.

Crider said Dhiab described how he came to witness the nurse’s evolution toward refusing to tube feed across two or three months of treatment the prisoner called “very compassionate.”

“Initially, he did carry out his orders and participate in the tube feedings,” Crider said he told her in a July 10 telephone call. “Once he saw with his own eyes that what he was told was contrary to what was actually taking place here, he decided he could not do it anymore.”

Crider said Dhiab quoted the nurse as announcing, “I have come to the decision that I refuse to participate in this criminal act.”

The Pentagon calls its Guantánamo tube feeding practice humane and designed to prevent a prisoner from starving to death. Defense lawyers say their clients consider it torture.

A federal judge, Gladys Kessler, agreed recently. In May she ordered the Pentagon to stop force-feeding Dhiab but reversed herself days later. She’s said she’ll hold a hearing on the issue later this summer, including a bid by news organizations to get copies of prison videos of detainees being tackled and shackled and taken from their cells to tube feedings.

As explained to visiting reporters, who don’t see tube-feedings, a Navy medical team uses a calculus of meals missed and weight lost to decide when to recommend a once or twice a day tube feeding of a can of Ensure or other nutritional supplement. The camps commander, a Navy admiral who is not a doctor, approves each feeding and orders guards to deliver a specific shackled hunger striker to medical staff.

Guards shackle him into a restraint chair and a nurse inserts a tube up his nose, down the back of his throat and into his stomach for nasogastric feeding. A sailor trained as a medic then manages the feeding.

Before flat-out refusing, Dhiab told Crider, the nurse at times waived a doctor’s order to do a tube feeding:

“Here, whenever a person has a fever or is sick, the typical force-feeding crew were still very rough with you,” the lawyer quoted the detainee as saying. “However, when he came to the block and saw that the person had a fever or was sick, he would say, ‘OK, because you are sick, you are not able to receive force-feeding’ and left them alone for that day.”

Crider said that the officer should be allowed to tell his story to Kessler despite any nondisclosure agreements detention center staff are obliged to sign.

“If he wants to give that evidence he should be allowed to give it,” she said.

At the height of the hunger strike last summer more than 100 detainees were refusing to eat, according to the U.S. military. At one point a record 46 prisoners were designated for tube feedings. That figure dropped to 11 then rose to 15 before the prison pulled the plug on daily transparency.

Miami Herald reporter Carol Rosenberg tweets @carolrosenberg

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