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On  February 6th PHR Israel appealed to the court and to the Ministry of Health to allow the immediate and urgent medical examination of Khader Adnan Mousa, A Palestinian Administrative Detainee, who is on his 52nd day of hunger strike.

18 December 2011: Khader Adnan Mousa, 34, from ‘Arabe, near Jenin, detained by Israeli forces on 17 December, went on a hunger strike one day after his arrest as a protest against his administrative detention and his humiliating and cruel conditions of interrogation.

29 January 2012: PHR-Israel appealed urgently to allow one of their physicians to see Mr. Mousa, in keeping with guidelines drawn from the World Medical Association (WMA) Declaration of Malta of 1991, as well as Israeli law. Mousa conditioned his referral to a hospital on being examined by PHR-Israel’s physicians. Once such a commitment was granted by the Israel Prisons Service (IPS), two of PHR-Israel’s doctors met him at the hospital, (Assaf Ha-Rofeh, 29th Jan) examined his condition and answered his questions regarding the current and predicted effects of his hunger strike. He decided to continue his hunger strike. Since that examination Mr. Mousa has conditioned further treatment on examination and follow-up by PHR-Israel’s doctors. He clearly stated to his attorneys that he wishes to be examined and consulted by PHR Israel’s doctors and will make his decisions according to their assessment of his condition. However, this request was not respected. Instead of ensuring Mr. Mousa’s rights, the IPS has transferred him from one hospital to another – 5 medical institutions in 8 days – in what seems to be a non-medical, unethical manner. As a consequence, he is refusing to be treated by IPS doctors or by doctors in the several hospitals he has been referred to since[1].

Mr. Mousa was referred on February 6th to Ziv hospital in Safed and is currently hospitalized there. He has not been allowed to see independent doctors since the last visit by PHR-Israel’s physicians.
With no examination, and no doctor he can trust, PHR-Israel is very concerned his medical condition is unclear and gives reason for grave concern since he is now on the 52nd day of his hunger strike.
By refusing to allow an independent doctor to examine Mr. Mousa the Israeli authorities are disregarding his precarious medical condition as well as several international directives:

The UN Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment, Principle 25: “A detained or imprisoned person or his counsel shall, subject only to reasonable conditions to ensure security and good order in the place of detention or imprisonment, have the right to request or petition a judicial or other authority for a second medical examination or opinion.” http://www2.ohchr.org/english/law/bodyprinciples.htm

The WMA emphasises the importance of confidence in hunger striker-doctor relationships: “Since the person’s decisions regarding a hunger strike can be momentous, ensuring full patient understanding of the medical consequences of fasting is critical. Consistent with best practices for informed consent in health care, the physician should ensure that the patient understands the information conveyed by asking the patient to repeat back what they understand.”

Following the IPS refusal to allow Mr. Mousa to be seen by an independent physician he trusts, PHR-Israel appealed to the district court to order the IPS to allow PHR-Israel’s doctor in. PHR-Israel also appealed to the Ministry of Health who has the authority over civilian hospitals and can – if they so wish – represent such patients’ rights.

The expected effects of a hunger-strike: According to the World Health medical association[2], after the 42nd day of a hunger strike, it is expected that individuals will begin to lose their hearing and vision, and suffer bleeding in the gums, intestines, and esophagus. The body will gradually stop functioning. After the 45th day, there is a high risk of death due to vascular system collapse and/or cardiac arrest.

PHR Israel therefore urges you to:
a. Contact the appropriate Israeli authorities and urgently request that, in accordance with Israeli prison regulations and international guidance, Mr. Mousa be allowed to see PHR-Israel’s doctors, who are independent doctors of his choice, and to consult regularly with them while on hunger strike.
b. Consider being present at Mr. Mousa’s court hearings, and requesting permission to visit him at the civilian hospital he is currently held in.
c. we urge you to request information regarding reports that he was shackled in previous hospitalization despite his weakened condition. This practice is counter to proper medical practices and ethics.

Because of our fear for Mr. Mousa’s health and the urgency of the case, please do not hesitate to contact Hadas Ziv (054-6623232) or Amany Dayif (054-9431854) personally by phone or email at any time of day or night in order to request further detail or update us on progress.
Our emails: [email protected]; [email protected]

[1]Medical Center IPS, Assaf Ha-Rofeh, Ma-ayanei Ha-Yeshua, Bikur Holim, Ziv,.