Ethics of Hunger Strike

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Asylum seekers have undertaken hunger strikes in Australia since the introduction of mandatory detention in 1992. Detainees take such measures that compromise the ethical authority of the state, due to fears of imminent repatriation, delays in processing, as well as the compound effects of trauma, stress and isolation. Studies have found high rates of depression and other such disorders, particularly amongst those held for prolonged periods (Kenny et al. 2004.).

The Declaration of Tokyo, 1975, adopted by the World Medical Assembly, explicitly forbids medical personnel from engaging in force-feeding hunger strikers on the condition that they have been assessed as ‘capable of forming an unimpaired and rational judgement’ concerning the consequences of their actions (Australasian Psvchiatry. 1994).

Currently the Australian Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) can authorise physicians, under Migration Regulation 5.35, to provide non-consensual medical treatment to detainees, which can include enforced feeding to hunger strikers (Kenny et al. 2004.). This authorisation does not compel medical practitioners to enforce the treatment, however practitioners are likely to be under pressure by their conditions of employment. Decisions are further complicated by often conflicting government, administrative, clinical and employment issues — not to mention a practitioner’s personal position regarding the regimes of restricted entry and mandatory detention, which remain controversial.

When access to and the movement of hunger strikers are restricted by the state, as is the case for prisoners and detainees, it has been argued that those who do have access have heightened responsibilities (Wei and Brendel. 2010). The state also has a duty of care to preserve the life of those in its custody.

A well established common law principle upholds an individual’s right to self-determination including the right to refuse treatment even if this is tantamount to suicide. When an individual is detained and in the care of the state, tension arises between upholding the individual’s autonomy and the state’s responsibility in the preservation of life.

Hunger strikers are often accused of being manipulative and engaging in ‘emotional extortion’ by authorities. According to a study in the United States asylum seekers undertake hunger strikes in the early phase of detention to express their distress and opposition to incarceration. In later stages of detention, especially after refugee claims have been rejected, hunger strikes commonly represent a desire to die rather than be forcibly removed or repatriated (cited in Kenny et al. 2004).

How are governments compromised by this form of protest? If authorities were to relent to hunger strikers would it not set a precedent for other asylum seekers to follow? In centres where access is limited, news of such actions and the authorities’ response can be kept confidential so as not to  raise alarm, or encourage the spread of such tactics amongst detainees elsewhere, however sympathetic staff, activists, and at times the asylum seekers themselves have been able to alert the public via means such as social media.

On 16 November 2012 a 35-year-old Iranian asylum seeker, Omid Sorousheh was taken to Nauru hospital after being on hunger strike for thirty-six days. He was returned to the Nauru Regional Processing Centre on 25 November and under the watch of four security guards, after the hospital declared it was no longer able to care for him.In a statement released on November 25 he said:

I will not stop my hunger strike until they transfer me back to Australia or I will die here [on Nauru]. What is the difference between me and the others who come [to Australia] after 13th of August [and who will] be given bridging visas and be released to Australia. But me and 399 more must be stay here in [Nauru] in a very bad situation. [1]

The Nauru government claimed to have no knowledge of the situation. [2]

On 30 November, and close to death, Sorousheh was air lifted from Nauru and taken to Australia for treatment after being on hunger strike for fifty days. The Department of Immigration released a statement saying that Sorousheh would be returned to immigration detention at Nauru as soon as he was deemed fit to travel.

Sorousheh’s evacuation was followed by a series of scuffles, ‘self-harms and attempted suicides’. According to activists and sources on Nauru, at least another eighteen detainees had also joined the hunger strike for more than a week, with one man believe to have been on strike for more than thirty days. [3] All hunger strikers are demanding that Nauru be closed and asylum seekers there be returned to Australia to have their claims processed. [4] Nauru ratified the UN Refugee Convention in June 2011, however a report released by the UNHCR in December 2012 states that its regional processing centre used by Australia falls short of international protection standards having assessed that its ‘accommodation conditions were harsh, a fully functioning legal framework was absent and [that] there was inadequate capacity to assess refugee claims.’ [5]

art-nauru-hunger-strike-620x349
Hunger strikers on Nauru. Photo: Clint Deidenang

At its onset in early November the Nauru hunger strike peaked at around 300 people, many who stopped after twelve days when they were informed that Amnesty International would inspect the island. Amnesty International also called for Nauru to be closed in a report that admonishes the Australian Government for ‘spectacularly failing in its duty of care to asylum seekers’ and that it can see no purpose for holding asylum seekers on Nauru other than to penalise them. [6]

As detainees were transferred to an Australian immigration detention centre operating in the remote Manus Island, Papua New Guinea, reports confirmed that hunger strikes had spread there also after the asylum seekers were told it could take four to six years for their claims to be processed.

By 10 December Omid Sorousheh was once again back on Nauru, days after hundreds of other asylum seekers were released into community detention, leading to speculation that he will resume his protest. In a press release, Refugee Action Coalition spokesperson Ian Rintoul stated:

It is a cold calculated decision that puts Omid’s life at risk again. [7]


[1] Refugee Action Coalition (2012). Nauru hunger strike continues. Fears grow for Omid after 46 days [Press release], 26 November.
[2] Maley, Paul (2012). Hospital clears hunger striker ‘close to death’, The Australian, 27 November.
[3] McClymont, Alison and staff (2012). Nauru ‘in meltdown’ as hunger striker evacuated, PM ABC News [online] 01 Dec 1, 2012.
[4] Refugee Action Coalition (2012). Nauru hunger strike continues. Fears grow for Omid after 46 days [Press release], 26 November.
[5] UNHCR. (2012). UNHCR Mission to the Republic of Nauru 3-5 December 2012 Report. [online] 14 December.
[6] Amnesty International (2012). Nauru camp a human rights catastrophe with no end in sight [report], 23 November.
[7] Refugee Action Coalition. (2012). Refugee groups condemn hunger striker, Omid, being forced back to Nauru [press release] 10 December.

Bibliography:
Kenny, Mary A, Silove, Derrick M and Steel, Zachary. (2004). Legal and ethical implications of medically enforced feeding of detained asylum seekers on hunger strike, Medical Journal of Australia, Vol.180 1 March. 237—240.

Australasian Psvchiatry. (1994). Ethics statement on asylum-seekers on hunger strikes, Australasian Psvchiatry Vol 2. No 6 December. 306—7.

Wei, MD, JD, Marlynn and Brendel, MD, JD, Rebecca W. (2010). Psychiatry and Hunger Strikes, Harvard Human Rights Journal, Vol. 23. 75—109.

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