Embassy of the State of Palestine

Ahead of Palestinian Prisoners’ Day (April 17th) - and in light of the prolonged hunger strike currently waged by Palestinian Prisoner Samer ‘Issawi, as well as recent reports detailing the deaths of several Palestinian security prisoners - PHR-Israel releases an extensive report exposing a long list of medical ethics and human rights violations carried out by the IPS, specifically by prison medical
practitioners, that endangered the lives of prisoners and detainees on hunger strike. According to PHR-Israel, the violations are a direct result of situating prison medical services under the auspices of the IPS, which operate largely out of security considerations.

The struggle of Palestinian prisoners made headlines last year when five administrative detainees waged prolonged hunger strikes in protest of their detention. Ahead of last year’s Palestinian Prisoners’ Day just one year ago, 1,600 additional Palestinians launched a mass hunger strike as a show of support and solidarity with those already on prolonged strike, and in protest of the conditions of their incarceration. The hunger strikes made the Israeli and international publics conscious and aware of the arbitrary policies that the State of Israel and the IPS pursue and implement vis-à-vis Palestinian prisoners.

At the time of drafting, Samer ‘Issawi, originally freed under the agreement that secured the release of Gilad Shalit, then arrested again, is still on hunger strike. As the hunger strikes continued, over the course of 2012, PHR-Israel bore witness to medical ethics and human rights violations, including violations of the right to health and deviations from professional standards, carried out by the prisoners’ treating physicians. Violations even reached the point of placing the lives of prisoners and detainees in immediate danger. Problems of medical conduct are prevalent not only with regard to the treatment of hunger striking prisoners; they involve other cases, too. Over the last year, several security prisoners have died in incarceration; the latest of which were Arafat Jaradat and Maysra abu Hamdiyyeh and before that Ben Zygier, cases which raised suspicions over inadequate conduct by IPS medical staff and their treating physicians. Moreover, PHR-Israel receives dozens of complaints a year from Israeli inmates detailing medical neglect and the overall failure of the IPS medical system to respond to their needs. Palestinian prisoners in need of medical treatment, and their families, worry that their fates might end up like their peers’ who lost their lives as a result of the poor and inadequate services rampant in the prison system.

Written by PHR-Israel staff Amani Dayif and Hadas Ziv, the release of this report aims to trigger a process that affords greater protections to prisoners and detainees, especially those on hunger strike. PHR-Israel’s report surveys the hunger strikes waged by over a dozen Palestinian prisoners over the course of 2012. It features an analysis of the conduct of Israel’s various health institutions and medical staff. By looking through the prism of binding professional codes of ethics, the authors examine the extent to which these bodies were able to stand up to the challenges that the hunger strikes generated.

The report suggests that the ways in which the IPS medical system dealt and handled the cases of hunger strikers over the past year, underlines the high extent to which the prison medical system is amenable to the prison system, which is in turn amenable and subordinate to Israel’s political echelons. Information gathered over the course of the year also raises concerns that on account of this subordination, the prison medical system in fact operates according to political and security considerations, rather than medical considerations, the former of which runs contrary to the interests of the hunger striking patient. Furthermore, they worsen situations of dual loyalty (in which physicians have responsibility to the patient on one hand, and to their employer on the other), a problem already rampant among medical practitioners employed by the IPS.

As long as the IPS medical system remains under the control and management of the prison system, with its political and security considerations, dilemmas of dual loyalty will be resolved by a drastic tilt in favor of the interests of the prison system, resulting in greater harm to the rights of prisoners, specially the rights of prisoners and detainees on hunger strike. In view of this, PHR-Israel calls for the establishment of a committee that will examine the possibility of transferring control and responsibility for the medical services inside the prisons from the Israeli Prison Services to the Ministry of Health. Such a transfer would make the level, availability, and quality of services, equal - if not on par – with the type of services accessed by the general population.

In a letter sent by the Israeli Ministry of Health to PHR-Israel on April 3, 2013 in response to the report, the Ministry accepted several of the organization’s main recommendations and even pledged to implement them, for example, a new regulation mandating the transfer of advanced-stage hunger strikers to civilian hospitals for appropriate care and monitoring.

Unfortunately the Ministry of Health does not see itself as the body responsible for supervising and regulating the health of prisoners. In an additional response letter received from the Ministry of Health several days later, the Ministry maintained that supervision and control over the medical services of prisoners would remain under the auspices of the IPS, thereby thwarting our request to initiate a committee on grounds that splitting up roles and responsibilities would not be in the prisoners’ best interests.

PHR-Israel clings to the position that fostering a process towards the transfer of responsibility from the IPS to a professional and public medical body will ensure optimal care among the prisoner population with regard to quality, availability, and accessibility. A number of countries and public health institutions consider the advancement of the rights of prisoners synonymous with the advancement of public health, and are inching toward full equality when comparing the health of prisoners to the health of civilians.

Among countries that have already removed responsibility for the health services from prison authorities, considerable improvements are noticeable, both with regard to improvements in the level of services, regarding a reduction in the amount of harm sustained as a result of rights-based offenses. Several countries are examining similar plans. It is fitting for Israel, led by the Ministry of Health, to do the same. Until then, the IPS medical system will continue to operate as if behind a screen, with no transparency or professional supervision, and with high potential to Further infringe on the rights of prisoners and detainees.

Outline of the report: Chapter One, The hunger strikes: background and course of event, accounts for the main motivations underlying the hunger strikes and describes how the strikes were conducted. The chapter mentions the various struggles used against administrative detention and other abusive policies used against prisoners and detainees. The chapter also provides brief accounts of the hunger strikers who's cases were handled by PHR-Israel. Chapter Two, IPS conduct during the hunger strike, discusses, at length, the failure of the IPS health system to adequately care and treat prisoners and detainees on hunger strikers. This failure is reflected in – among other things - the IPS' refusal to allow independent physicians to monitor and examine hunger strikers; failure to provide adequate and sufficient medical follow-up; failure to transfer medical files and information to independent attending physicians as required under the Israeli Patients’ Rights Law. Chapter Three, Courts responses to IPS violations, discusses how the Israeli courts handled issues presented to them during the hunger strikes. Cases related particularly to consistent violations carried out on the part of the IPS of the rights of hunger strikers as encapsulated in international law, Israeli law and the IPS procedures. Chapter Four, Conduct and responsibility of Israel’s medical establishments, analyzes the involvement of Israel's medical establishments in the issue. The chapter details actions taken by the Israeli Medical Association (IMA), the Ministry of Health (MoH) and hospitals staff and administrations. In our view, none of these bodies acted sufficiently to prevent harm to hunger strikers, nor to ensure that professional and ethical standards where adhered to and respected while administering needed treatment.

The report concludes by outlining the changes in structure and values that are necessary in order to ensure greater respect for and protection of prisoners’ rights. We call for hunger strikes to cease being considered disturbances to prison order subject to punishment; an end to the isolation of hunger strikers; an end to the fining of hunger strikes; an end to the confiscation of their belongings; and an end to the denial of family visits. PHR-Israel believes that it is necessary to add the topic of prisoner's health to the regular curriculum of all medical and nursing students, and that the curriculum must include the ethical and clinical aspects of treating hunger strikers. In the meantime, we propose the development of a focused training program to be offered to both IPS physicians and hospital physicians, which will include information relating to the clinic and medical ethical and clinical treatment issues that arise when treating patients on hunger strike.

PHR-Irael recommends a number of additional steps that will ensure greater protection of the rights of hunger strikers: the establishment of an independent, external system of monitoring and oversight for the medical treatment of hunger strikers; investigation of all complaints submitted on behalf of hunger strikers by PHR-Israel and other organizations regarding suspected violation carried out by the IPS, its medical services, or other bodies, relating to the treatment and handling of hunger striker cases; investigation of complaints of abuse, violence and other harm to prisoners and detainees on hunger strike caused by prison guards.

Several immediate steps to ensure greater protection of the rights of hunger strikers should be implemented without delay: the adoption of ethical standards regulating the treatment of hunger strikers, in line with principles outline in the Malta Declaration; Adherence to the Israeli Patients' Rights Law which guarantees that hunger strikers have the same rights as any other patient; Unrestricted and continued access of independent physicians to monitor, follow-up and treat hunger strikers who request an independent doctor, as frequent as the independent attending physician shall; the transfer of advanced-stage hunger strikers to hospital and ensuring that their hospitalization continues to the end of their hunger strike and throughout the recovery period; refrain from shackling hunger strikers who are admitted and are receiving treatment in civilian hospitals.

For the full report click here.