News outlet Al-Jazeera has obtained an internal document detailing the US military's approach to the ongoing hunger strike by more than 100 detainees being held at the offshore detention center at Guantanamo Bay.
Central to the document—a Standard Operating Procedure (SOP) manual—is the manner in which 'force-feeding' will be instituted by prison personnel and includes sections titled "General Algorithm for a Hunger Strike" and "Strategy for Detainee Biting Feed Tube".
Al-Jazeera asked Leonard Rubenstein, a lawyer at the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Heath and the Berman Institute of Bioethics, to review the SOP document for his impressions.
Rubenstein said the military's guidelines were especially troubling because doctors and nurses are reminded that they are "adjuncts of the security apparatus" and not authorized to "act independently" in their duties as health professionals.
According to Al-Jazeera, "The SOP grants Guantanamo Cmdr. Smith - not physicians - with the final authority to select hunger-striking prisoners for force-feedings."
"It is a very frightening idea that the medical staff is an adjunct of the security force," said Rubenstein who used the word "Orwellian" to describe the situation. "The clinical judgment of a doctor or a nurse is basically trumped by this policy and protocol. Doctors are not acting with the kind of professional medical independence. It's clear that notwithstanding references to preservation of detainee health in the policy the first interest is in ending the protests."
The 30-page manual contains the most detailed descriptions to date pertaining to the treatment of hunger strikers and prisoners who undergo force-feedings. The SOP replaced a previous SOP issued in 2003 - revised in 2005 - which was declassified several years ago by the Pentagon, albeit with redactions. The new, unredacted policy obtained by Al Jazeera went into effect March 5 - one month after Guantanamo prisoners launched their protest over the inspection of their Qurans.
The procedure appears to have been revised and implemented in order to deal with a mass hunger strike.
"Just as battlefield tactics must change throughout the course of a conflict, the medical responses to GTMO detainees who hunger strike has evolved with time," says the SOP. "A mass hunger strike was successfully dealt with in  by utilising procedures adopted from the Federal Bureau of Prisons and the approach delineated in this SOP.
"However, the composition of the detainee population, camp infrastructure, and policies has all undergone significant change since the initial version of this SOP… Much of the original instruction has been retained in the form of enclosures. In the event of a mass hunger strike, these enclosures can be utilised as they have proven efficacy under mass hunger strike conditions."
The SOP notes that there are a number of prisoners who have been hunger striking since 2005, who have "proven their determination", and whose physical frailty have limited Guantanamo authorities' "options for intervention". The document goes on to say, "in the event of a mass hunger strike, isolating hunger striking patients from each other is vital to prevent them from achieving solidarity".
On April 13, guards staged a predawn raid at the communal camp and isolated more than 100 prisoners into single cells in an attempt to bring an end to the protest.
Read the full report and see the documents here.