David Nicholl [neurologist at Queen Elizabeth Hospital, Birmingham, UK; British human and medical rights activist]: "The legal black-hole of Guantanamo is well recognised, however it is less well realised how the ongoing breaches of medical ethics in Guantanamo are damaging the normally high standards of US medicine. In June 2006, I and over 250 physicians criticised the use of forcefeeding and restraints on Guantanamo Bay hunger strikers as being in breach of accepted international treaties such as the Declarations of Malta and Tokyo. I lodged formal complaints regarding one of the physicians concerned with the Medical Boards for Georgia and California in February 2005 and also pointed out to the American Medical Association, a co-signatory to the Declarations of Tokyo and Malta, that at least one of the doctors concerned was an AMA member. Over a year later, none of these esteemed bodies have replied or taken any action. Sadly, the medical establishment has a good track record of failing to investigate such matters. For example, in apartheid South Africa 30 years ago, the regulatory authorities initially failed to take any action against the negligent treatment in custody of the activist Steve Biko who died whilst being interrogated. Ironically, the authorities initially claimed he had died as the consequences of being on prolonged hunger strike. It was only grass-roots doctors who ended up taking action to have the 2 doctors responsible reprimanded eight years later for their complicity with torture.

Thus it should be no surprise to have the recurrence of hunger strikes again in Guantanamo with the absence of any proper legal process after over 5 years of detention. Doubtless the solution will be the use of more of the restraint chairs which proved so effective at ending the 2006 hunger strike. The challenge now is what action will the US medical establishment take to restore its reputation. A doctor's first duty, even in the military, is to respect patient autonomy as stated by the International Red Cross in their guidance for the management of hunger strikers.

Guantanamo has become a by-word for the abuse of both the principles of law and medical ethics. The failure of the US medical establishment to take action over such abuses is to be lamented. Their silence is deafening."