Supporting Someone on Hunger Strike

If the person you are visiting goes on hunger strike this will likely be challenging and upsetting for you. You should ensure that you work closely with your group coordinator and can call AVID for assistance. This is not to say that the visitor’s role is a passive one, as visitors are in a position to provide valuable support. However, it is to be expected that a hunger striker will evoke a range of often conflicting emotions, from feelings of hopelessness and powerlessness to frustration and concern. It can be helpful to talk this through with others to help make sense of how you are feeling and make sure that your own worldviews and emotions are separated from those of the person you are visiting.

Visitor groups might have different approaches according to their own safeguarding policy, and there is no overarching consensus within the medical community about how to respond to someone on hunger strike. However, there is explicit positioning on matters such as force feeding, which the World Medical Association holds that “force feeding constitutes a form of inhuman and degrading treatment."

Immigration detention is an inherently disempowering experience, and our role should be to try and empower people as much as possible in this context. Hunger strikes can be a form of asserting control, so it is important that we do not try to instruct people on what to do. Our role is to provide support, information and advocacy as required so that they are making informed decisions, but we should remain guided by them throughout this process.

Visitors must not feel that it is their duty to take responsibility for the detained person’s life. A decision to refuse food or fluids can only be made by the detained person, and that person will benefit from continued support and practical help without judgment.

Any of the following actions may be of help to a person in detention refusing food or fluids:

• Most importantly, talk to the people in detention about why they want to go on a hunger strike. Be mindful that peer pressure could play a role, especially in collective strikes. It is also important to ascertain whether someone is refusing food/ fluid as a deliberate hunger strike, or if this is due to mental health or other concerns.

• Find out what the person knows about how their body will respond and how they will feel if they refuse food or fluids. It is important that the person appreciates the importance of continuing to take fluids with sugar and salt, otherwise decline can happen quickly not leaving enough time for negotiation and discussion with the authorities.

• If someone has prior or ongoing medical issues, there might be increased risk or a more rapid decline of their health. If they are on medication, their decision to stop or continue use should also be carefully considered.

• It is important to communicate that some pain killers can cause further harm during a hunger strike due to the risk of internal bleeding. This is especially true of ibuprofen and other NSAIDs (nonsteroidal anti-inflammatory drugs).

• You can give the person a copy of Department of Health information ‘ Refusing food or drink – prisoner or detainee advice sheet’, found at Appendix 1 of Department of Health, (2010), Guidelines for the clinical management of people refusing food in immigration removal centres and prisons . This is available here . I t may be useful for visitors to print a copy and refer to this in their discussions wi th people in detention as it provides useful information on what the legal rights are for someone on hunger strike as well as the physical effects of food and fluid refusal. For example:

“ If you are well nourished when you begin to refuse food, and you a re prepared to take adequate fluids, you are unlikely to die from starvation for at least six to eight weeks, even if you eat nothing. However, you will be affected in some ways very quickly. Weakness and lowered resistance to infection can occur within th ree days of refusing all food and, if you are already undernourished when you stop eating, or you have any illness, survival will be much shorter. ”

• Try to have a conversation about how realistic the chance of success is, whatever the person considers success to be. It can also be helpful for them to have a clear idea of what success means for them, and under what conditions they are willing to stop their strike.

• Make sure that the person understands the Home Office policy on hunger strikes and their rights (outlined in Food and Fluid Refusal) including the possibility of requesting a Healthcare safeguarding reports: Rule 35 and Rule 32.

• With the persons consent, you can make a referral to Medical Justice for an independent medical assessment.

• Be aware that anyone who stops refusing food who has had little or no nutrient intake for ten days or more, needs specialist clinical support and advice on eating and drinking (refeeding) , and may require hospital admission.

• It is difficult to determine when hunger strikes reach a critical point due to individual differences . It is important t o continue phoning and/ or visiting someone on a hunger strike and t o keep your group coordinator informed , especially as someone’s health deteriorates.

• It can be helpful to develop a plan with your group coordinator about when to escalate matters (including making a Medical Justice referral). While all visitors should first follow their group’s guidelines and directions, it is important to centre the dignity and wishes o f the person on hunger strike, and to be as transparent as possible with them.

• With the consent of the person you are visiting, keep the detained person’s solicitor informed of any serious hunger strike or fluid refusal. If the detained person does not have a solicitor, you could consider helping the m with Finding a legal advisor .

• With the person’s consent, make a referral to the Independent Monitoring Board (IMB).

• Be aware that a detained person who ha s been refusing food or fluids may be re leased from detention at short notice by the Home Office, and may need help to set up support in the community.