Position Paper - Physicians for Human Rights - Israel - April 10, 2012

Bilal Diab and Thae'r Halahla, administrative detainees, are on the 41st day of their hunger strike. Bilal Diab's medical condition is particularly serious because he stopped drinking water on April 8.

As a result of a petition to the court, an independent doctor from PHR-Israel was allowed yesterday, April 9, to visit and examine Mr. Halahla, and Mr. Diab.

Bilal Diab, 27 years old, from Kofer Rae'i, near Jenin. He was first arrested when he was a boy, 17-years-old, and was sentenced to seven years in prison. Attempts to rebuild his life after his release from prison in August, 2010, failed in part because of repeated arrests for several days at a time, summons for interrogations, and repeated searches of the family home and of the business he opened, which made it impossible for him to lead a normal life. Mr. Diab was arrested on August 17, 2011, when a large number of soldiers broke into the family's home, firing at its inhabitants as well as employing tear gas and concussion grenades. Bilal and his brothers were treated very violently during their arrest. After an interrogation lasting more than one month in Kishon Detention Center (Jalameh), he was informed that an order had been issued to hold him in administrative detention for six months. On February 14, 2012, the administrative detention order was extended for an additional six months.

Thae'r Halahla,, 34 years old, from H'rsan near Hebron, has been held in administrative detention since June, 2010. He is married and the father of a 22-month-old baby girl who was born after his arrest whom he hasn't seen since her birth. Mr. Halahla has been arrested many times, usually under an administrative detention order. Before his current arrest, he was held in administrative detention for three months in 2000, for eight months in 2001, for one year in 2004 and for one year in 2005. He was arrested in 2007 two weeks after his wedding and placed in administrative detention for a year.
At the beginning of January, 2012, his administrative detention order was extended a third consecutive time for an additional six months.

On March 1, 2012, Bilal Diab and Thaer Halahla, began a hunger strike to protest the renewal of the administrative detention orders against them, joining the protests against administrative detention led by detainees Khader Adnan and Hana Shalbi. Following a deterioration in their medical condition, Mr. Diab and Mr. Halahla, were transferred about three weeks ago from Ketziot prison to the IPS medical center in Ramle (Marash). After losing consciousness a number of times, Mr. Diab, was hospitalized twice at Assaf Harofeh Hospital, but was subsequently returned to Marash.

On March 22, 2012, PHR-Israel addressed an urgent request to the IPS that independent physicians be allowed to visit Mr. Diab and Mr. Halahla. Because the request wasn't granted, an urgent appeal was submitted on April 1 to the Petah Tikva District Court, demanding that independent physicians be immediately permitted to enter the prison and examine the detainees in private, without shackles. PHR-Israel also demanded that additional visits be allowed after the first, as frequently as the independent physician determines is necessary.

On April 4, 2012, Judge Avraham Tal decided that the independent doctor's visit would occur during April.
It should be emphasized that PHR-Israel views limiting visits to hunger strikers by independent physicians and placing obstacles in the way of such visits to be a serious violation of the strikers’ rights and ignores the principles of medical ethics enshrined in the Malta Declaration. Preventing independent physicians from visiting hunger strikers increases their isolation and the pressure that can be inflicted upon them to end their strike, which could have the opposite effect - radicalizing the strikers and placing their lives at greater risk.

It is important for an independent physician to examine a hunger striker in order to establish the necessary trust between them. World Medical Association guidelines based on the 1991 Malta Declaration, as well as recommendations by the Israel Medical Association, emphasize the importance of prison hunger strikers being examined by an independent and neutral physician who is not identified with the prison authorities.

The doctor who visited Mr. Halahla yesterday determined that his condition was commensurate with that of a person on a prolonged hunger strike, but was stable. If he continues his hunger strike, it will be impossible to prevent his condition from deteriorating.

Mr. Diab’s condition, on the other hand, is of great concern, because on April 8, 2012, he began refusing fluids, either orally or intravenously, as well as any other treatment. Mr. Diab said during the visit that were he to be transferred to a civilian hospital he would reconsider hydration. Mr. Diab's request to be transferred to a civilian hospital is understandable in light of the extreme mistrust inmates feel towards prison physicians who are fully identified with the prison authorities.

According to the World Medical Association, "the body is unable to survive without liquids more than a few days, and in most cases the hunger striker will die during the first week." At this point it is essential to transfer Mr. Diab to a hospital so that his condition may be monitored continuously in order to prevent a further deterioration in his condition and even save his life.

The examining physician expressed concern about the fact that laboratory tests are performed only once every week or ten days, rather than at least every two or three days, as they should be. The physician also noted that although the prison doctor visits Mr. Diab and Mr. Halahla every day, he does not examine them. He recommended a medical examination be conducted at least daily, and more than once a day in the case of Mr. Diab. The doctor also recommended that medical personnel continuously monitor them throughout the day and that the IPS permit the detainees to contact their families.

PHR demands:

1. To immediately transfer Bilal Diab to a civilian hospital.
2. That IPS allow independent physicians to visit hunger strikers regularly and that the visits be conducted in privacy, without the presence of IPS personnel, including doctors.
4. That IPS allow the hunger strikers to be in contact with family members, including visits.