On 6 February, human rights group Physicians for Human Rights-Israel appealed to an Israeli court and to the Ministry of Health to allow the immediate medical examination of Khader Adnan Mousa, a hunger-striking Palestinian Administrative Detainee, by an independent doctor of his choice.

On 7 February, the 53rd day of the hunger-strike, a doctor's visit took place. The visit  gave rise to serious concerns for his health and life. Although a visit by a PHR-Israel doctor has now been enabled twice (the first visit took place on 29 January), in both cases a prison guard was present and refused to enable a confidential doctor-patient consultation. 

Mousa, who was seen shackled by both his legs and one arm to his hospital bed in Safed, Israel, refuses to be treated or seen by prison or hospital doctors without receiving a guarantee that the medical information will not be passed on to the prison authorities or to the secret police (known variously as Shabac, Shin Bet, GSS or ISA).

Medical and ethical issues

PHR-Israel believes that the recommendations of the World Medical Association should be followed and can be of help in Mr. Mousa's case, if unnecessary death is to be avoided. The recommendations of the Malta Declaration of the WMA are clear: "Physicians should talk to hunger strikers in privacy and out of earshot of all other people, including other detainees. Clear communication is essential and, where necessary, interpreters unconnected to the detaining authorities should be available and they too must respect confidentiality."

PHR-Israel is now seeking assistance in appealing to the Israeli authorities to allow Khader Adnan to be examined in privacy by PHR-Israel's doctors, and to ensure his medical confidentiality, as his life is at stake. According to PHR-Israel, without such an examination they cannot follow his medical condition, and cannot give him accurate information that can adequately inform his decision to continue his hunger strike.

Background:

18 December 2011: Khader Adnan Mousa, 34, from 'Arabe, near Jenin, detained by Israeli forces on 17 December, went on a hunger strike one day after his arrest as a protest against his administrative detention and his humiliating and cruel conditions of interrogation.

29 January 2012: PHR-Israel appealed urgently to allow one of their physicians to see Mr. Adnan, in keeping with guidelines drawn from the World Medical Association (WMA) Declaration of Malta of 1991, as well as Israeli law. Khader Adnan conditioned his referral to a hospital on being examined by PHR-Israel's physicians.

Once such a commitment was granted by the Israel Prisons Service (IPS), two of PHR-Israel's doctors met him at the hospital, (Assaf Ha-Rofeh, 29 Jan) examined his condition and answered his questions regarding the current and predicted effects of his hunger strike. He decided to continue his hunger strike.

Since that examination Khader Adnan has conditioned further treatment on examination and follow-up by PHR-Israel's doctors. He clearly stated to his attorneys that he wishes to be examined and consulted by PHR Israel's doctors and will make his decisions according to their assessment of his condition. However, this request was not respected. Instead of ensuring Adnan's rights, the IPS transferred him from one hospital to another – 5 medical institutions in 8 days – in what seemed to be a non-medical, unethical manner. As a consequence, he is refusing to be treated by IPS doctors or by doctors in the several hospitals he has been referred to since.

6 February 2012: Khader Adnan was referred to Ziv hospital in Safed and is currently hospitalized there.

7 February 2012: Following PHR Israel's insistence, in addition to a doctor's visit, a family visit was granted to the hunger striker. His wife, Randa, and two daughters visited him at 09:30 AM. The visit lasted 45 minutes. During the visit Mr Mousa was shackled by both legs and his right arm to his hospital bed, and could not hug his daughters and wife. He was under guard.

According to his family, Mr. Mousa's clothes were dirty, his fingernails were not trimmed for a long time, and he has started to lose his hair. His body odor was unpleasant, and his wife estimated that he has lost a third of his weight. He reported feeling that he was 'fading away', that he suffers from chest pains, and feels he had days, maybe hours, to live.

Relevant international directives 

The UN Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment, Principle 25:"A detained or imprisoned person or his counsel shall, subject only to reasonable conditions to ensure security and good order in the place of detention or imprisonment, have the right to request or petition a judicial or other authority for a second medical examination or opinion."

The World Medical Association (WMA) emphasises the importance of confidence in hunger striker-doctor relationships: "Since the person's decisions regarding a hunger strike can be momentous, ensuring full patient understanding of the medical consequences of fasting is critical. Consistent with best practices for informed consent in health care, the physician should ensure that the patient understands the information conveyed by asking the patient to repeat back what they understand."

The expected effects of a hunger-strike 

According to the World Medical Association, after the 42nd day of a hunger strike, it is expected that individuals will begin to lose their hearing and vision, and suffer bleeding in the gums, intestines, and oesophagus. The body will gradually stop functioning. After the 45th day, there is a high risk of death due to vascular system collapse and/or cardiac arrest.

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