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Hunger Strike at Guantanmano Bay

Aired May 3, 2013 - 15:00:00   ET


CHRISTIANE AMANPOUR, CNN HOST: Hello, everyone, I'm Christiane Amanpour, and welcome to the special weekend edition of our program. This week, the ongoing hunger strike at Guantanamo Bay prison.

Closing Guantanamo was the first promise that President Obama made when he first came into office and now more than 100 days into his second term, it is still open for business, with 166 prisoners trapped in what is really a legal limbo.

The president blames Congress for tying his hands and he vows to take on the issue again.


OBAMA: It hurts us in terms of our international standing. It lessens cooperation with our allies on counterterrorism efforts. It is a recruitment tool for extremists. It needs to be closed.


AMANPOUR: But critics say he could use his executive powers today to at least order the release of 86 prisoners who've already been cleared for transfer. In the meantime, Guantanamo has become a grim struggle to keep alive more than 100 prisoners who would rather die than stay at the detention facility forever.

More than 20 have lost so much weight on their hunger strike that they are being force-fed. It is an excruciatingly painful and ethically questionable procedure. I spoke with one of the country's leading experts on medical ethics about force feeding. And we'll turn to that in a moment.

But first, Col. Greg Julian is a public affairs chief for the U.S. Southern Command, which oversees Guantanamo. I spoke with him from Miami earlier this week about this issue.

AMANPOUR: Welcome to the program.

COLONEL GREG JULIAN, PUBLIC AFFAIRS CHIEF, U.S. SOUTHERN COMMAND: Yes, thank you, Christiane. It's a pleasure.

AMANPOUR: Is there any hope that these 86 are going to be transferred?

JULIAN: I really can't comment on the transfer. Our task force in Guantanamo is charged with the safe and humane care and custody of the detainees. And we really have no involvement in the decision about their legal status.

AMANPOUR: Right. I'll follow up with you in a moment on that. But when you say safe and humane treatment, let me quote to you from Samir Naji al Hasan Moqbel, who is one of the prisoners there and who wrote a "New York Times" column, saying that, "Gitmo is killing me."

He says, "The situation is desperate now. All of the detainees here are suffering deeply and there's no end in sight to our imprisonment.

"Denying ourselves food and risking death every day is the choice that we have made."

Is there any doubt in your mind that this will not end until there's at least a death?

JULIAN: No, I really don't anticipate that. We have a good medical staff on board. There are currently 21 detainees that are being enterally fed. And five of those are being observed in the detainee hospital. And there are no life-threatening circumstances at this point.

AMANPOUR: Well, probably because they are being force-fed, as you say. We have heard the excruciating pain of that force-feeding.

I'd just like you to walk me through what your medical staff do to make those 21 or so eat.

JULIAN: Well, this is the same procedure that's used in civilian hospitals for people that are in a condition where they're unable to eat normally. And a tube is fed through their nasal passage into their stomachs. And then they're fed a nutritional supplement.

AMANPOUR: Do you -- you would agree with what the lawyers are saying, that it's pretty invasive and pretty painful?

JULIAN: I -- no, I wouldn't agree. This is a legally approved procedure followed by the Federal Bureau of Prisons. And we adhere to the same procedures.

AMANPOUR: Now one of your staff -- or rather the sort of Muslim adviser to the staff at Guantanamo Bay is quoted in a press report as saying that -- well, he believes that this is going to go on until there is some kind of resolution to this transfer.

Do you agree, as some other officials down there in the Southern Command feel, that this is really about this stalemated situation that they're in, that they have lost all hope?

JULIAN: I really wouldn't want to speculate on what the detainees think. That's really not our lane. We're just responsible for providing for their care and custody.

AMANPOUR: All right. Well, let me play this bit of an interview that I did with one of the defense attorneys not long ago. This is what he said on our program.


CARLOS WARNER, DEFENSE ATTORNEY FOR GUANTANAMO DETAINEES: I'm not here to argue about the numbers. I'm here to call on the president to end this strike. And he can do that if he would just pay some attention to what has happened in Guantanamo. They've been accused of nothing. They are not only innocent, but the government has agreed they're not dangerous to release.


AMANPOUR: So here we are in this kind of Kafkaesque situation.

What is the exit strategy for some of these prisoners? Is there any hope that they will get released, particularly those who are not accused and are, you know, have already been approved for transfer and who now have that blocked?

JULIAN: Well, I think there's a misunderstanding of that term, that they've been approved for transfer. That means that they've been approved for transfer to another country's detention facility. It doesn't mean that they're innocent and it doesn't mean that they're cleared to be released into the public.


AMANPOUR: Right. But even they're not being removed. And some of them think that maybe they could go back to their own country if they would host them, and at least their families would be there. At least they'd get out of this black hole in Guantanamo Bay.

So the question is, is there any kind of procedure to your knowledge that is going to allow that to happen?

Or are they there forever?

JULIAN: That's really out of our lane. That's for others to decide. We're really only responsible for maintaining their care and custody.

AMANPOUR: So what is the process then for these -- for the 86 in question? Who is the -- whose lane is it in?

JULIAN: Well, the Office of Military Commissions conducts the commissions process. And then the political leaders will determine the transferability of the detainees.

AMANPOUR: So political leaders are.?

JULIAN: Our government.

AMANPOUR: All right. Well, some -- go ahead?

JULIAN: That's really outside of our lane.

AMANPOUR: Right. Some members of Congress have said that that's just kind of a stalling tactic, and the Pentagon just doesn't want to move on this issue, because they say they've issued leeway that certain, you know, discretion can be used in this -- in this matter.

Has -- how do you answer to that?

JULIAN: It's really inappropriate for me to comment on that.

AMANPOUR: All right. What can you say?

JULIAN: That we take our job very seriously and we are ensuring for their care and custody. We moved them into single cell procedures because at a point the detainees had damaged or covered more than 100 of the video cameras. And it made it difficult for us to monitor their medical well- being.

So we've had to return to this single cell type operation for the meantime. And we'll continue to do everything we can to provide for their care and custody.

AMANPOUR: Col. Julian, we've met before and, you know, I'm not trying to attack you. I know you're just a spokesman. But when you say care and medical condition and humane, I mean, these stories are really outrageous coming out of there. I know you think that nobody's going to die because you've got a tube going down into their stomach.

But what if somebody does die? What is that going to do there? And what is that going to say about America?

JULIAN: Well, we have an advanced medical team available to provide for their care. And we actually even brought in an additional medical team because we anticipated an increase in the number of hunger strikers. And we have the means to keep them alive and well and that's our intent.


AMANPOUR: You know that there have been a number of suicide attempts as well. That could increase.

JULIAN: Yes, that's potential. But by inspecting their cells and monitoring them closely, we're better able to prevent that from happening. There is no 100 percent solution to keep somebody that's determined to cause themselves harm. But we're doing our best.

AMANPOUR: Col. Julian, thank you very much for joining me.

JULIAN: My pleasure. Thank you.


AMANPOUR: When we come back, we'll seek a second opinion on the medical ethics at stake in Guantanamo. If the first commandment of medicine is "First, do no harm," is keeping prisoners alive against their will an act of conscience or cruelty?

But before we take a break, May 3rd is World Press Freedom Day, and this year's them is ensuring the safety of journalists, men and women who put their lives on the line every day in some of the most dangerous and repressive places on the planet. We'll be right back.




AMANPOUR: Welcome back to the special weekend edition of our program and a closer look at the ongoing hunger strike and the legal limbo at Guantanamo Bay prison.

President Obama says he does not want the hunger strikers to die. And to that end, the government is using the controversial practice of force feeding, also called enteral feeding, to keep them alive.

Here's how it works:


AMANPOUR (voice-over): Prisoners are forcibly restrained. They are tied to a chair. And a tube is passed through their nose to their stomachs so that a dietary supplement can be injected into their system. It's a process that can take two hours and it happens every day.


AMANPOUR: Prisoners report that the procedure feels like having a razor blade passed through their system. American courts have ruled that prison authorities may do this to preserve order.

But the American Medical Association and the World Medical Association condemn the procedure.

They say, quote, "Where a prisoner refuses nourishment and is considered by the physician as capable of forming rational judgment concerning the consequences, he or she shall not be fed artificially."


So is it ethical for the U.S. government to force-feed detainees?

Arthur Caplan is a world-renowned bioethicist at New York University's Medical Center. I spoke with him earlier this week.


AMANPOUR: Professor, welcome.


AMANPOUR: So the doctor's code is, "Do no harm." Is it doing more harm to force-feed or is it doing more harm to let them die?

CAPLAN: Well, the doctor's code is, "Do no harm," and it's also respect the autonomy or the independence of the patient. The patient has a right to say no to all medical treatments. We've established that again and again and again in the U.S. Think about Terry Schiavo. Think about Karen Ann Quinlan.

These are cases that say you can stop feeding; you can stop giving water if the patient doesn't want it. These patients are prisoners, but they don't want it. So the balance is, I think, don't treat them when they say and don't disrespect their right to refuse.

AMANPOUR: So how do you sort of rationalize that with what the military spokesman told us, that this is what we do in American hospitals and that we're being humane?

CAPLAN: Well, it is something that happens in American hospitals, but it's on very sick people and it happens once. It doesn't happen every day that they feed again; the tube comes in; the tube comes out. You're not going through that process.

Even in a hospital with a very, very ill bedbound patient, they often try to pull the tube out; they don't like it. It's not comfortable. So let's not kid ourselves. This is artificial feeding. This is not getting a meal on the end of a spoon that you don't want, like a baby saying I don't want to eat any more. This is a tough, tough way to eat.

AMANPOUR: And the global ethical standards talk about a rational patient or, you know, somebody who can actually make the difference between, you know, whether they want to or not and understands the consequences.

Are you sure that the prisoners at Guantanamo can do that?

Do you think any of them are unconscious or so ill that they can't make that decision?

CAPLAN: Not yet. They could fall into that state. Right now, I think what we've got is not a suicide attempt, it's a political protest. And I know people want to describe it as this is them trying to kill themselves; we don't allow suicide.

I think it's a different situation. It's a statement by prisoners, goes all the way back to the Irish hunger strikers against the British, saying I don't -- I can't live in these conditions. I don't accept the terms of my sentence that I'm under here. This is inhumane to me. This is the only way I have to speak up.

AMANPOUR: Well, I wanted to mention that. You brought up the Irish IRA hunger strikes. And of course, Bobby Sands was the most famous. He starves himself to death in 1981; nine others do so afterwards before it's called off by the Catholic Church and others.

I want to ask you about something the president said, that being in Guantanamo is a recruitment tool.

But surely the IRA found that this was also a recruitment tool, this idea of, you know, the hunger strike and what Margaret Thatcher allowed at that time.

Do you fear that this will actually backfire, that it will make it worse for the United States?

CAPLAN: I don't. Hunger strikes are a tough thing to do. I know we're talking about dozens and dozens of people going on hunger strike, but most fall away. It's very difficult to stay on a hunger strike.

I think the recruitment tools that are available out there, if you want to recruit people to the cause, this isn't it. I'm not worried too much about martyrdom.

What I am worried about is again and again going in there, saying we want to close this place. The prisoners understand and are trying to protest, and we're going to force feed them for conditions basically that we're already saying are unacceptable.


I want to ask you more about the physical impact of what's happening to them. We described a little bit; we showed that animation.

Tell me what it's like. And these people are now being forcibly restrained.

CAPLAN: So I've had it. I've had it done to me, just because I wanted to know what it was like. So it is --

AMANPOUR: Is it awful?

CAPLAN: I'd say it's pretty -- it's pretty rough. There's a difference between someone who's trying to comply and go along and someone who's bound to the chair and you're trying to get this tube in and down.

Then you've got to pour the solution down. These people are basically shackled and bound. They're not trying to accept the treatment. The more you struggle, the more you resist, the worse it is.

AMANPOUR: One of the lawyers that we -- who we've been talking to has got a client down there. And in a telephone call, heard the client say, the inmate, that, in fact, they're also trying to put bigger tubes down the throat, a 10 rather than an 8. I'm not sure exactly what that means --

CAPLAN: More nutrition --


CAPLAN: -- the size of the tube.

AMANPOUR: Show me how big it is.

CAPLAN: So you're probably talking about something like this, maybe a quarter.

AMANPOUR: OK. So the 10 is too big and induces vomiting. The 10 makes it hard to breathe. The entire body is tied down and the large tube is inserted.

CAPLAN: You feel that sensation like you're drowning as the stuff is poured down your throat. I don't want to say it's waterboarding, but it's certainly hugely uncomfortable. You can bring the food back up. If that happens, you're bound and gagged, now you're starting to aspirate, as we say, take it into the lungs.

If you're not properly trained and you don't do this a lot, you're not very good at it, at -- the best people have a hard time doing it. But doing it day after day, really rough.

AMANPOUR: Well, tell me then, because clearly I guess in Guantanamo they're trying to prevent or protect the actual medical staff from actually doing it. It seems that they are not medical staff who are doing it, although boatloads have been sent down there now to supervise it. We're told now it's practically a one-on-one ratio of a medical staff to an inmate.

CAPLAN: So it looks like they have corpsmen, nurses, not actually doctors. I don't think they have enough doctors there to do most of this - -

AMANPOUR: But isn't it also protecting the ethics of a doctor?

CAPLAN: I wish it were. I doubt it is. I think it's just raw numbers. I think they need more bodies to do this. There aren't 100 doctors that they can round up to go do force feeding in this prison. They're taking nurses and corpsmen -- that is kind of physician assistants -- doing it that way. I'm not saying they're not skilled at it.

But again, it's not the best circumstance. I know there are viewers out there, thinking, I don't care if they hurt these prisoners. These are people that are, you know, terrorists. They're not people I worry about.

The point of principle is we don't want to see a principle established that the government can go around making you accept medical treatment that you don't want, even if you are a prisoner. It's a bright line.

That's why the American Medical Association, World Medical Association, all the international groups keep saying we can't compromise a person's right to say no to artificial feeding or any other medical treatment.

AMANPOUR: Professor Caplan, thank you very much indeed.

CAPLAN: My pleasure.

AMANPOUR: Also to mention, actually, a lot of them haven't even been charged with anything and not even getting a trial.

Professor, thanks for being here.


AMANPOUR: And from the legal and ethical minefield that is Guantanamo, we'll turn to embattled Syria, another voice is being heard there above the gunfire, an Arab idol, crying for his country and touching hearts, when we come back.



AMANPOUR: And finally tonight, for more than two years, we've watched and we've reported while Syria tears itself apart.

But imagine a world where a love song can unite people on both sides of the battle line.

Recently, Abdul Karim Hamdan, an aspiring young singer from Aleppo, appeared on "Arab Idol." That's a hugely popular TV talent show based in Beirut and modeled on its British and American counterparts.

Hamdan chose to sing an old Arabic folk tune. But he rewrote the lyrics, making it a love song, not for a woman, but to Aleppo, the embattled hometown that he loves.


AMANPOUR (voice-over): Now the song brought the judges and the audience out of their seats. And overnight, his performance became a YouTube sensation, with 2 million views in just three days. But he also became a lightning rod for both sides in the civil war. Death threats appeared on Facebook and pro-government posts call him a traitor.

In answer to his critics, Hamdan says, "I sang for Syria, only Syria." And whether or not he goes on to win the competition, he has already won millions of hearts in his bleeding nation.

And that's it for tonight's program. Meantime, you can always contact us at our website, Thanks for watching and goodbye from New York.