What happens to your body when you go on a hunger strike?

In 1981, ten Irish republicans starved themselves to death in Northern Ireland, demanding to be recognised as political prisoners.

Their leader, Bobby Sands, survived 66 days without food before he died, and has become one of the most famous hunger strikers in history.

More than four decades later, a group of prisoners on hunger strike are making headlines again. They have been held on remand over protests for Palestine Action for over a year without trial. Four of them are still refusing to eat, while a fifth, Qesser Zuhrah, was last night reported to ended her strike after 48 days, having been hospitalised.

Two of the strikers have now gone 50 days or more with no food, and fears are growing of a tragic outcome. Earlier this week the sister of Kamran Ahmed told Metro how she dreads she will ‘have to do an obituary’ for her brother.

What actually happens to the body during a hunger strike?

James Smith, an A&E doctor and epidemiologist with UCL, who has been supporting those on strike, told Metro that the prisoners are now in a critical and unpredictable period for their health.

He said: ‘The reality is that they are in a physiological state where the body is breaking itself down, and there is an unpredictability to this. We know what the risks broadly are, but we don’t know when exactly those risks will materialise and in what way.’

The body can ‘very quickly’ go into cardiac arrhythmias, or progressive heart failure, and heart related issues are a particular concern at this stage, he said.

The other major concern is deficiencies of essential micronutrients. The big one is thiamine, which is one of the vitamin Bs.

‘Your body has quite a limited store, and you need thiamine in order to process energy,’ he said. If people become deficient, it can cause damage to the brain and the nervous system, which may not be fully reversible.

‘We’re in that territory now,’ he warned.

Dr Smith said it is hard to know exactly how well or badly the hunger strikers are managing, as communicaiton is limited even for their next of kin.

He spoke to one of the protesters, Qesser Zuhrah, around 10pm last Tuesday, when she was past day 40 without food. She told him she had severe chest pains, something she had also told her family at 5pm that day.

‘It wasn’t until 1pm on Wednesday that the ambulance came to the prison,’ he claimed, saying that the fact she remains in hospital now indicates the chest pain was a serious medical concern.

He said all those still on hunger strike risked long-term damage to their health, even if they ultimately survived: ‘You can do damage to the kidneys, the liver, the pancreas, the heart, and of course, to the entirety of the musculature, and there’s no guarantee that all of those things are reversible’

‘Something tragic could happen at any time’

It is now possible for something ‘tragic’ to happen at any time, he said, based on how other patients with acute malnutrition have progressed.

‘In anorexia, for example, it’s not necessarily the case that electrolytes slowly drop away: there can be very sudden and rapid changes that can be fatal. And most, if not, all of the hunger strikers now are in that phase.’

Ian Miller, a historian of hunger strikes in British prisons, told Metro that in the past, hunger strikes were unlikely to be fatal because authorities were willing to force-feed prisoners, such as the Suffragettes.

‘It’s often seen as very degrading, torturous and painful, and a way to subjugate patients and to encourage them to get off the hunger strike,’ he said.

By the 1980s, this was no longer favoured unless someone was severely mentally ill and irrational, and so ten prisoners jailed for involvement with the IRA or Irish National Liberation Army died. Dr David Ross, who was overseeing their care at the Maze Prison (Long Kesh), also went on to take his own life some five years later.

The fate of some of those who survived the IRA hunger strikes show the longterm impact even years after starvation, Dr Miller added.

Many suffered lifelong health conditions, with some dying young with stomach or health problems: ‘So you find sometimes, decades later, that the health has been impacted in a way you didn’t quite contemplate at the time.’

Legal action against the government

A legal firm representing the hunger strikers has said it submitted a pre-action letter on Monday against the Justice Secretary David Lammy, outlining the group’s intention to start legal action after activists were taken to hospital.

The strikers say the Government is abandoning its own policies in the prison safety policy framework.

Prime Minister Sir Keir Starmer has previously said the ‘rules and procedures; are being followed, after facing questions in the Commons about why his ministers had refused to meet with representatives of those striking.

Prisons minister Lord Timpson has previously said the service is ‘very experienced at dealing with hunger strikes, with an average of over 200 a year, and has ‘robust and working’ systems in place and the Prison Service ‘will not be meeting’ any prisoners or their representatives.

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