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Guantanamo force feeding trial: the US is wrong to medicalize hunger striking

BMJ 2015; 350 doi: (Published 11 February 2015) Cite this as: BMJ 2015;350:h669
  1. W John Kalk, locum consultant endocrinologist, Medway Maritime Hospital, Gillingham, Kent ME7 5NY, UK
  1. Correspondence to: wjohnkalk{at}

Legal wrangles continue after a US judge demanded videos showing forced nasogastric feeding in Guantanamo be made public. Force feeding should play no part in the care of mentally competent patients, says W John Kalk, who treated hunger striking prisoners in South Africa during the apartheid era

In 1998 I was asked by the Johannesburg Hospital to assume responsibility for the medical care of political prisoners admitted because of acute complications of hunger strike. Some 20 detainees, all young black men whom the apartheid government considered a “high security risk,” had been held in so called “preventive detention” by police for up to 32 months, some in solitary confinement.

The hunger strike was their protest against being held without charge under emergency regulations. The police medical services in Johannesburg had been unable to cope with large numbers of increasingly ill prisoners, who were admitted to local hospitals. In the Johannesburg Hospital they were housed in a single ward where they were guarded by heavily armed police and were periodically shackled to their beds. At that time there were some 700 such detainees on hunger strike throughout the country.

Hunger strikers were patients

The ethical and medical principles that we applied in the Johannesburg Hospital in the management of these prisoners have been published.1 2 In essence, they were our patients: the medical and nursing staff agreed to accept …

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