The ICRC’s role in hunger strikes and key working principles

Hunger strikes are a type of protest. Historically and worldwide, detainees have turned to hunger strikes to protest their detention, their treatment in detention or their conditions of detention. Detainees in Israeli places of detention at times have used, and continue to use, this same form of protest.

The ICRC does not judge the reasons or choices for such forms of protest, just as it does not generally take position on the reasons for which people are detained. Where possible, the ICRC will increase the frequency of visits to detainees on hunger strike, to monitor their situation more closely, with a focus on their health, family contact and well-being. ICRC visits aim to review the treatment they receive and their conditions of detention, to ensure they meet relevant international standards.

The detaining authorities are responsible for the health and medical follow up of all detainees on hunger strike. The ICRC’s visits to detainees on hunger strike do not replace the obligations and responsibilities of the detaining authorities in relation to their health and medical follow up of detainees. Regardless of whether a hunger striker refuses treatment or not, it is the obligation of detaining authorities to ensure access to appropriate care. This may include transfers to health facilities with the capacity to manage the extremely complex medical consequences of a prolonged hunger strike.

Our teams also remind the authorities of the importance of family visits. ICRC colleagues stay in contact with families throughout a hunger strike, to ensure they are kept updated about their loved ones’ situation, and of any visits to them conducted by the ICRC.

Crucially, as a neutral organisation, the ICRC cannot advocate for the end of a hunger strike, nor for the authorities concerned to agree with the striker’s demands. It can, however, encourage the strikers, their representatives and the authorities involved to keep communicating and maintaining contact to find a solution to avoid grave health consequences and loss of life.

The Q&A below offers an overview of the ICRC’s role in this regard, both during individual and collective hunger strikes, and the key principles underpinning our work.

What is the ICRC’s position and scope of work relating to hunger strikes?

The ICRC respects any detainee’s decision to start a hunger strike and neither supports nor condemns this decision. It also does not judge the merits or legitimacy of hunger strikes as a means of protest. Our position is that of a neutral intermediary urging those involved to find a solution and talk through demands.  

The scope of ICRC work relating to hunger strikers extends to their conditions of detention and their treatment. This includes visits from ICRC and private interviews with the hunger striker(s) to determine whether their treatment both is dignified and humane. When needed, the ICRC also engages with the detaining authorities on the problems they may have identified in a bilateral and confidential manner. If asked by the detainee, the ICRC informs the family of the visit.

What can the ICRC do when detainees go on hunger strike?

With the agreement of the detaining authorities, ICRC teams visit Israeli places of detention, or other facilities, when a hunger strike is in process. During this time, they carefully assess the situation to understand the issue(s) at stake. This is done through private interviews with the detainees, and discussions with the prison managers, custodial staff and health staff involved.

During any hunger strike, the ICRC urges both the detaining authority and the detainee to find a solution. It strives to ensure that the rights and physical and mental integrity of detainees on hunger strike are respected. This includes respecting their choice to continue or to abandon the hunger strike, and their right to proper care and treatment as required by their condition, if they consent to it.

Subject to authorization by the detaining authority, the ICRC aims to assure regular visits to detainees from the start of their hunger strike through to its resolution, to assess their health condition and the medical care they receive both in places of detention and in hospital facilities to which they may be transferred. ICRC delegates also stay in contact with the families of detainees on hunger strike.

Are there any activities falling outside the scope of ICRC work during hunger strikes?

The ICRC operates differently to other international or non-government organisations working on detention-related issues. Due to its mandate, the ICRC is granted access to detainees that is generally denied to many other organisations. While some international organisations often take public stands on issues relating to detention, such as hunger strikes, due to its confidential dialogue with authorities, the ICRC will seek to limit its public communication.

The ICRC does not publicly provide health updates on a hunger striker’s condition due to this confidential dialogue with authorities.

The ICRC is not a source for statistics on hunger strikes: these are provided by the detaining authorities.

As a neutral humanitarian actor, it is not ICRC’s role to pronounce itself on the legitimacy or not of the demands of the detainees and/or to promote them, nor question the reasons for their detention.

The ICRC is unable to seek or obtain the release of hunger strikers.

The detaining authorities are responsible for the health and medical follow up of all detainees on hunger strike. The ICRC visits to detainees on hunger strike do not replace the obligations and responsibilities of the detaining authorities towards detainees on hunger strike especially in relation to their health and medical follow up.

The ICRC does not take part in the negotiations between the authorities and the detainees on hunger strike. It can act as a neutral intermediary if asked by both sides.

Regardless of whether a hunger striker refuses treatment or not, it is the obligation of detaining authorities to ensure access to appropriate treatment. This includes transfers to health facilities with the clinical capacity to manage the extremely complex medical consequences of a prolonged hunger strike.

What is the role of an ICRC medical doctor during a visit to detainees on hunger strike?

ICRC medical personnel play a specific and crucial role: they assess the medical condition of detainees on hunger strike and seek to ensure that their refusal to intake food is based on a voluntary decision and in full knowledge of the possible consequences of fasting on their health and life. An ICRC doctor must also attempt to make sure the hunger strikers are not suffering from a mental illness. If they were, it would call into question the strikers’ capacity to make a voluntary and fully informed choice to refuse nourishment. ICRC health staff also provide hunger strikers with independent and confidential medical advice.

ICRC doctors speak with the health staff managing the hunger strikers, to ensure the medical care available meets current technical and ethical standards, and that options for hospital transfer exist if needed. This dialogue is especially important regarding the critical health issues that can arise from prolonged fasting or alternatively, from resuming nourishment after a prolonged fast, should the hunger striker choose to cease his strike. It is the decision of the detainee on hunger strike to accept, refuse or cease medical treatment. Regardless of whether a hunger striker refuses treatment or not, it is the obligation of detaining authorities to ensure access to appropriate treatment exists. This includes transfers to health facilities.

If deemed necessary – for instance during collective hunger strikes – the ICRC may also mobilize additional staff (including medical) and resources.

What is the ICRC’s position on the forced feeding and forced treatment of detainees?

The ICRC is opposed to forced treatment of mentally competent patients hunger strikers: the choices of mentally competent and fully informed patients to accept or refuse medical treatment must be respected: forced treatment by health staff of a mentally competent hunger striker constitutes a grave violation of internationally accepted medical ethics.

Moreover, the ICRC considers forced feeding of mentally competent hunger strikers as a form of ill-treatment, which may constitute a violation of international human rights, criminal and humanitarian law. The ICRC aligns its opposition to the forced feeding of hunger strikers to the World Medical Association’s, as expressed in the Declaration of Malta (1991/2017) and the Declaration of Tokyo (1975/2016). Specifically, the latter states: "Where a prisoner refuses nourishment and is considered by the doctor as capable of forming an unimpaired and rational judgment concerning the consequences of such voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of the prisoner to form such a judgement should be confirmed by at least one other independent doctor. The consequences of the refusal of nourishment shall be explained by the doctor to the prisoner."