Hunger Strike in Prison: The Law and the Right to Die from Starvation

Azerbaijani political opposition figures, who are pursued and placed in detention centers and other places of confinement, resort to the last means of protest—a hunger strike. In most cases, prison authorities claim they are unaware of the inmate’s hunger strike; in rarer cases, if the hunger striker nears death, they are transferred to the medical unit. Recently, a unique incident occurred in this context—the head of Detention Center No. 1 in Baku awarded a certificate of commendation to National Front Party of Azerbaijan member Famil Khalilov, who had been on a hunger strike for more than 50 days, for his exemplary behavior.

What rights does the law provide to a prisoner on a hunger strike, and what responsibilities does the leadership of the Penitentiary System have in this situation? These and other questions were addressed to Turan by the head of the Human Rights Center of Azerbaijan, Eldar Zeynalov, who responded to Turan's questions.

The Hunger Striker = a Disorderly Inmate

-How has the attitude of the post-Soviet state toward hunger strikes as a form of prisoner protest changed?

-Refusing food or going on a hunger strike is one of the long-standing and widespread methods of protest in prisons. However, in Azerbaijan, it was not immediately recognized as a legal form of protest—this only happened 20 years ago, after a series of collective hunger strikes by inmates in Gobustan Prison, who were subjected to harsh punishments as a result.

From the administration’s perspective, refusing food was viewed as the same violation of the prison schedule as refusing to attend the morning roll call or going to bed after lights out. Inmates saw this step as a forced way to express their negative opinion about changes in the law and conditions in the prison. Incidentally, after 20 years, based on recommendations from international organizations, the prisoners were eventually transferred from Gobustan to Umbaki, where the conditions are much closer to European prison standards.

Back then, in February 2004, the first instruction was introduced, which categorized the refusal to eat into “justified” and “unjustified” hunger strikes and defined the actions the prison administration should take depending on the type. If the prisoner’s demands were deemed “legal,” i.e., based on the provisions of the “Code for the Execution of Punishments” and the “Internal Regulations,” the administration was to take immediate measures to meet them or inform the prisoner that the legal demands could not be fulfilled in a short time due to objective reasons. If the reason for the hunger strike was considered disrespectful (unjustified), the prisoner was provided with a comprehensive explanation of this, and their actions could be deemed a violation of the regime, leading to consequences such as punishment and a damaged record.

-What regulations govern the administration’s treatment of a hunger striker?

-Currently, the second “Instruction on the Conditions of Detention and Forced Feeding of Convicts and Detainees Refusing to Eat in Penitentiary Institutions” (No. 32-N of December 30, 2012) is in effect. The text of the current document can be found on the “Unified Legal Acts Database” website at the following link: e-qanun.az.

It should be noted that the demands of a hunger striker, if not put in writing and not verified by the administration, do not exist for the external bureaucratic world. In such cases, a situation arises where relatives report a hunger strike, but the prison administration denies it, claiming that no statement about the hunger strike was received. There have even been instances where the administration illegally refused to accept a statement about a hunger strike under various pretexts, requiring the intervention of a lawyer.

What Happens Next?

-Describe the procedure in the “administration-hunger striker” relationship.

-After the prisoner declares a hunger strike during the morning roll call or at breakfast distribution, the head of the penitentiary institution or the detention center, or a designated officer, must meet with them. This officer must determine the reasons for the hunger strike, including speaking with the inmate personally. The hunger strike is reported to the leadership of the Azerbaijani Penitentiary Service (or Nakhchivan) and, if the person is under investigation or on trial, to the body conducting the criminal proceedings. The head or doctor of the medical unit, who informs their superiors (the Medical Department), participates in the conversation.

The refusal to eat is documented in writing, after which the prisoner should be provided with the appropriate conditions. These include isolating the inmate from those who could secretly pass on food and removing all food from the room. Usually, the inmate is placed in a separate ward of the medical unit, or in isolation or a solitary cell. If the hunger striker is not isolated from other inmates (except for collective hunger strikes where several hunger strikers can be placed together), it is a clear sign that the hunger strike is not officially registered by the administration and is being conducted in vain.

Within 24 hours of the start of the hunger strike, a medical examination of the hunger-striking prisoner is conducted to assess their psychological and overall health. In particular, the doctor must carefully and comprehensively examine the patient for diabetes, acute gastritis, peptic ulcer disease, epilepsy, and other metabolic disorders that are contraindications to refusing food. If one of these diseases is detected, the hunger strike is prohibited for medical reasons. In other cases, the hunger striker is informed that such actions are harmful to their health.

From the moment of isolation, the hunger striker is under medical supervision and two registration sheets are filled out for them daily. One sheet records notes about the issuance and return of food three times a day (the food is offered to eat and taken away after two hours). The other sheet records complaints and physiological indicators: pulse, body temperature, weight, blood pressure, the amount and frequency of fluid intake (15-30 liters per day), mental state, and laboratory indicators. These sheets are inserted into the medical history or medical card. If the refusal to eat lasts more than a week, general blood and urine tests, as well as a biochemical blood test, may be performed. If necessary, outpatient treatment and emergency medical care can be provided in the room where they are held.

At the same time, the prisoner must fulfill all other duties in the prison, participate in investigative actions, and attend court hearings. They can be sent to other places of detention but accompanied by medical personnel. Only a doctor’s conclusion can release them from work or transport from the prison. Currently, a more lenient option exists—remote participation in interrogations, court hearings, or meetings via video communication.

- What are the health consequences for a hunger striker in places of detention?

-Prolonged fasting causes a series of unpleasant sensations: a feeling of hunger, constant weakness, sleep disturbances, stomach discomfort, a weakened immune system, and swelling. Body temperature and blood pressure decrease, and the pulse drops to 60 beats per minute. Some mistakenly believe that in this condition, one should move more to avoid swelling and warm up the body. In reality, as experienced hunger strikers have told me, one should actually move less.

If the condition of a person refusing food worsens, they are sent to the Medical Facility (the central prison hospital). There, they are again offered food and given a detailed explanation of the importance of ending the hunger strike, persuading them to start eating.

The next step is the application of medical measures, i.e., forced feeding. For this, a dietary mixture prepared according to the doctor’s prescription is used, consisting of easily digestible products given in small portions with a daily nutritional value of at least 3,000 kilocalories. The procedure for forced treatment is painful and, in some cases, can cause breathing problems and heart issues, so the doctor keeps everything necessary for emergency medical care on hand.

In the decision on the case "Nevmerzhitsky v. Ukraine" (No. 54825/00), the European Court of Human Rights ruled that forced feeding cannot be considered degrading if it is necessary to save a person’s life. However, forced feeding without medical necessity and causing pain (using a feeding tube, handcuffs, or mouth spreaders) can be equated to torture.

In this context, a semi-comical case comes to mind, where hunger-striking inmates at Gobustan Prison, whom I mentioned earlier, were shown a rubber hose of substantial diameter, with the statement that if they continued the hunger strike, they would be fed rectally (you understand what that means). This was a joke, as no one is actually fed in that way during a hunger strike, but not everyone knew that. In fact, if the hose were used in reality, it could significantly lower a person’s status among the prisoners. This tactic worked on many protest participants, and they stopped the hunger strike. But the effect was temporary, as the inmates soon found out they would be fed from the other end, and they laughed at the dark humor of the prison staff.

Hunger Strike and Death

-Can someone die from starvation in an Azerbaijani prison?

-A regular hunger strike, i.e., refusing any food but consuming water, leads to death from starvation in about 2 months (60-70 days). A dry hunger strike, i.e., refusing both food and water, results in dehydration and death in 3-10 days. Some of the hunger-striking prisoners, in this context, threaten to continue their hunger strike until death.

However, it is the duty of the prison doctor to prevent a fatal outcome, and they will not allow the hunger striker to die. When there is a life-threatening risk to the prisoner and reason to believe that they have lost the ability to make adequate decisions regarding themselves, the decision to resume feeding forcibly is made by the doctor, who can consult with a psychiatrist. If the hunger striker threatens to take their own life, they may be legally placed in a psychiatric hospital (Article 11 of the Law on Psychiatric Assistance).

If the prison doctor conducts an examination of the inmate inadequately and fails to consider all illnesses, then even such usually non-lethal stress as a hunger strike can kill a person. This is what happened in 2007 to political activist Faina Kungurova, who was arrested in normal physical condition but with a slightly agitated mental state. Her psychological state was not considered, and the hunger strike killed her.

-Sometimes the administration claims that the prisoner is not on a hunger strike. What does this mean?

-I cannot fail to mention cases when hunger strikes are simulated to attract more attention to oneself and thereby "actualize one’s case," as one of my acquaintances in custody put it.

As I mentioned earlier, with a regular hunger strike without medical intervention, a person dies in 2 months, and with a dry hunger strike—in one and a half weeks. Therefore, if someone has been on a hunger strike significantly longer than these periods and is still not being forcibly fed, such a case usually raises doubts among critical thinkers. For prison guards and doctors, these doubts are professional. After all, if it turns out that the hunger strike is fake, the hunger striker automatically becomes a malingerer and a violator of the regime and will be punished.

This is why unexpected searches are conducted in the room where the hunger striker is held. However, the creative imagination of prisoners also comes into play, as they find various ways to pass high-calorie products to their "hunger-striking" comrades. For example, in one of the cases known to me, prisoners soaked shirts and underwear with sugar syrup and sent them to the hunger strikers in the medical unit, so they could soak them in water and enjoy sweet water. I had only heard about such practices before in relation to drug smuggling.

The older generation still remembers how, during the perestroika years of 1986-87, a certain Dr. Charles Hyder, widely publicized in the Soviet press, set up a tent near the White House in Washington and announced a fatal hunger strike against the arms race and nuclear weapons. He drank water with sea salt, took vitamins, and lasted without food for 218 days (7 months). Some explained his phenomenon by the obesity of the 56-year-old Hyder, who weighed 136 kg at the start of the hunger strike at a height of 188 cm; others considered him a fraud, and his hunger strike—a partial one (once a week he would go home to “take a shower”).

A partial hunger strike, when a person still consumes something to maintain energy, can last a long time and does not lead to death. In essence, it can be considered a dietary regimen or therapeutic fasting, which frees the body from excess fat. For example, it was said about Hyder that he decided on a hunger strike because his doctor allegedly recommended that he lose weight (he did lose 77 kg). Thanks to his hunger strikes, he may have lived another 17 years.

I know inmates who regularly cleanse their bodies this way, sustaining themselves on sweetened water, juices, or milk. This type of fasting not only improves health (it is used to treat such diseases as pancreatitis, cholecystitis, enterocolitis, hypertension, vascular atherosclerosis, arrhythmias, etc.) but is also a good practice that allows one to endure a real hunger strike longer than other inmates who usually give up on the fifth day. As preparation for a hunger strike, high-calorie food is usually consumed the day before. A traditional dish before a hunger strike is, for example, khash, which, in addition to its caloric value, creates a gelatin reserve in the body, necessary for joints, nails, and hair.

There are also inmates who, for one reason or another (e.g., fear of poisoning), refuse prison food but eat home-prepared food instead. Prison administrations are tolerant of this practice, relying on medical supervision.

Naturally, a partial hunger strike that does not pose a danger to life is not perceived by the public as a method of protest.

As someone who has been studying prison rules for more than 30 years, I do not recommend that any inmate imitate Hyder by devaluing their possibly legitimate protest with theatrical declarations of “dry” and “fatal” hunger strikes, only to break them after a few days or months of simulating food refusal. A hunger strike is too dangerous a method of protest to undertake without being physically and mentally prepared.