Yumna Patel & Mariam Barghouti
Mondoweiss / May 6, 2023
Rights groups, experts, and Khader Adnan’s legal team say that Israel caused his death through deliberate medical negligence and cruel and inhumane treatment. In other words, Israel wanted him dead.
When news broke early Tuesday morning, May 2, that veteran Palestinian prisoner Khader Adnan had died inside an Israeli prison, headlines poured out one after the other, attributing the cause of death to his 86-day hunger strike.
Headlines from Israeli and mainstream Western media outlets highlighted claims by Israeli prison authorities that Adnan had “refused medical treatment.” The message: his death resulted from his choices and actions.
But Palestinian and international rights groups, along with Adnan’s family, legal team, and those close to him, tell a very different story of the cause of Adnan’s death. The Palestinian people have hailed him as a martyr and have adopted a common consensus that seems to be backed by experts and rights groups: Adnan did not just die, he was killed — or at least, Israeli prison authorities, the courts, and security apparatus, let him die.
While the direct cause of his death is undoubtedly the havoc that starvation wreaked on his organs, his family and rights groups say that a number of violations were committed by Israeli prison authorities and military courts that exacerbated his deteriorating health condition and actively played a role in his death.
Addameer, a Palestinian prisoners’ rights group, condemned Israeli authorities for what it described as the “willful killing” of Adnan. The Palestinian Prisoner’s Club accused Israel of “executing” Adnan, saying there was a “premeditated order” pushed against the prisoners. Physicians for Human Rights Israel, whose doctors monitored and visited Adnan, said the Israeli hospitals and courts ignored their pleas regarding Adnan’s dire medical condition in his final days. According to his wife, lawyer, and medical experts, the deterioration in Adnan’s health was expedited by the mistreatment and cruel practices of the Israeli Prison Services (IPS).
The nature of the accusations against the Israeli authorities can be described as two separate practices: first, that there was intentional medical negligence on the part of the Israeli authorities in the case of Khader Adnan’s health while on hunger strike; and second, that the IPS deliberately subjected him to physical conditions and exertions, as well as psychological “torture” tactics, that put additional strain on his already frail body, with the intention of exacerbating his condition.
In other words, Israel wanted him dead.
Deliberate and ‘willful’ medical negligence
The primary accusation against Israeli authorities is “deliberate medical negligence.” Amnesty International, Physicians for Human Rights Israel, Addameer, Al-Haq, and other human rights groups have cited medical negligence as the chief cause of Adnan’s death.
“The sustained and purposive practice of medical neglect [by the IPS], including the denial of hospital care to Khader despite a medical emergency, and withholding his visitation rights, as well as the international community’s routine failure to prosecute atrocity crimes committed against Palestinians, constitute a grave and systemic breach of the Geneva Conventions, which is directly responsible for Khader’s death,” the Palestinian Human Rights Organizations Council (PHROC) said in a statement following Adnan’s death.
Simply put, Khader Adnan’s family, the Palestinian people, and human rights groups all agree: Khader Adnan’s life could have been saved, but Israel insisted on doing the opposite.
Adnan’s most recent strike was his fifth individual and longest-running hunger strike since 2004. His previous strikes in 2014, 2018, and 2021 lasted 54, 58, and 67 days, respectively.
When Adnan was arrested on February 5 of this year, immediately launching his hunger strike in response to his detention, Adnan’s wife told Mondoweiss that he had just returned from a medical visit in which his doctor informed him that he was suffering from gastrointestinal bleeding. As a result of his previous strikes, Adnan’s family and doctors familiar with his case say he was already suffering from a number of medical conditions exacerbated by the most recent strike — something Israeli authorities should have considered but did not.
“During his recent incarceration, Khader was already at a heightened risk of heart attack and organ failure because of his past hunger strikes, which had led him to the precipice of death several times. Yet, the IPS refused to transfer him to a hospital in April, after he became seriously ill, despite him needing urgent medical care,” PHROC said in a statement.
Throughout his three-month-long detention until his death, what medical treatment and observation Adnan did receive was conducted at the Ramleh prison clinic, where Palestinian prisoners have long complained of policies of medical neglect on the part of doctors and prison authorities. For the duration of his hunger strike he was also held in solitary confinement.
Following his death, the IPS claimed that it had taken Adnan to the hospital on “numerous occasions,” but that he had “each time refused medical treatment” and was transferred back to the Israeli prison clinics.
“He decided to go on hunger strike, and he refused any medical examination and any medical treatment,” IPS spokeswoman Hana Herbst told The New York Times, adding, “We couldn’t have done anything different other than forcing him to take medical treatment, which we can’t do.”
But according to PHRI, Dr. Qasem Hassan, and Adnan’s attorneys, Adnan did not refuse medical treatment in the way that Israeli authorities claimed. Adnan allegedly requested to be hospitalized numerous times, but under the condition that he be allowed to receive family visits (which he was actively being denied), that a PHRI doctor accompany him, and that his medical records not be shared with the IPS and Israeli intelligence. The IPS refused these demands and thus said Adnan was “refusing medical care.”
Responding to the accusations that Adnan was uncooperative, Dr. Qasem Hassan said: “That’s what a hunger strike is all about. He doesn’t cooperate because he doesn’t trust the Israeli medical teams. He believes all his medical information they will collect will be shared with prison and security authorities and used against him. That’s why he asked that PHRI follow up on his situation.”
Dr. Qasem Hassan added that she “tried to persuade” Adnan to take minerals and vitamins and do blood tests and that it “won’t affect his struggle for freedom.”
“But he felt otherwise. He asked his family to be with him in order to cooperate, but nobody cared. Nobody cared what happened to him. The courts made sure that no one will twist the arm of the Israeli authorities,” she said.
Additionally, the Palestinian Prisoners’ Club claimed that throughout this hunger strike, Israeli hospitals refused to admit Adnan to their facilities despite attempts by Adnan and his legal team. “Israeli hospitals refused to admit him,” Amany Sarahneh, a spokesperson for the PPC told Mondoweiss.
Amnesty International also reported that a doctor who visited Adnan during his hunger strike told Amnesty that “authorities had denied him access to the independent specialized medical treatment and monitoring he needed.”
“The doctor said Khader Adnan had requested to be kept under medical supervision in a civilian hospital, but the Israeli Prison Service had sent him back to his prison cell where guards came in every half hour to see if he was still alive. The denial of proper medical treatment to Khader Adnan was a violation of his right to health and constitutes inhuman and degrading treatment,” Amnesty said.
The information was corroborated by both Adnan’s leading lawyer Jamil al-Khatib and Adnan’s wife, Randa Moussa. “More than once, [Adnan] requested being taken to the hospital,” Al-Khatib explained to Mondoweiss.
Similar testimony was given by Dr. Qasem Hassan, who said that several Israeli hospitals had refused to admit Adnan after he made brief visits to their emergency rooms.
She said the doctors at the Israeli civilian hospitals turned him back because he asked for medical confidentiality and that his records should not be shared with prison authorities. The hospitals allegedly used that as grounds that he was “refusing care” and turned him back.
However, according to Al-Khatib, this was because Adnan was taken for a hospital check-up during the early weeks of his hunger strike, when he was still able to walk, even if barely. It was then that Adnan refused the medical check-ups.
“All hunger strikers usually do this,” legal expert and researcher Dana Bulous, who had met Adnan after his first long individual hunger strike in 2011-2012, explained to Mondoweiss. “They refuse the performance of medical tests on them,” she said. In this, Adnan recognized that hospital doctors will do what the military commands, and that he was not in safe hands. That was the pretext used by Israeli authorities as to why Adnan will remain in the prison clinic, unmonitored, where he was ‘found unconscious.’”
As Adnan’s health further deteriorated, the appeals made to the Israeli courts by Al-Khatib to transfer Adnan to a hospital were rejected. At the same time, on April 30, a decision was given to Al-Khatib, which noted that his lawyer would be immediately informed in the case of changes in Adnan’s health.
“Despite this, I was not informed of anything. I woke up in the morning and saw information on his death and had to make calls myself on that basis to confirm. They did not inform me [as his representative],” Al-Khatib said.
“The medical teams in the Israeli hospitals crossed a red line of medical ethics,” Dr. Qasem Hassan told Mondoweiss. “You can’t discharge a person to die in a prison because of political issues,” she continued. “It’s a huge violation of medical codes.”
“The majority of [Israel’s current] ministers consider every Palestinian prisoner a ‘terrorist which should be eliminated,’” Bulous said. “They consider administrative detainees to be ‘terrorists’ that do not deserve to get medical care in Israeli hospitals and do not deserve to get their fair trials,” she said.
“This is not right ethically,” Dr. Qasem Hassan said. “Even if a patient does not cooperate with me as a doctor, I’m obligated to guarantee his right to get proper medical care in case of an emergency.”
When asked if she believed the hospitals, prison authorities, and government were willfully neglecting Adnan’s rights as a patient over political reasons, Dr. Qasem Hassan said: “Somebody, somewhere said he should be discharged to die in jail.”
“I think something changed in the policy. Somebody decided this man should die. That’s what it feels like to me,” she clarified.
Collaboration of the military courts
As Adnan’s condition continued to deteriorate in the weeks before his death, Israeli military courts denied Adnan’s legal team requests for his immediate release so that he could receive proper medical treatment.
“For weeks, following a severe deterioration in his condition, we tried to convince the Health Ministry, Kaplan Hospital, and the IPS to keep Adnan hospitalized. The IPS clinic was not equipped to monitor Adnan and could not provide emergency intervention in case of sudden deterioration,” PHRI said in a statement.
“I saw him through a video conference from Salem while he was in Ofer,” Randa Moussa, Khader Adnan’s widow, told Mondoweiss almost two weeks before he died in Ramleh prison clinic. “His condition was miserable, he looked incredibly exhausted. It was the first time I saw him after being on hunger strike for a while.”
Dr. Qasem Hassan similarly described Adnan’s condition in the days leading up to his death, describing him as “extremely weak.”
Less than ten days before Adnan died, Dr. Qasem Hassan visited him on April 23 at the prison clinic. At that time, he weighed around 125 pounds and had difficulty moving and breathing.
Dr. Qasem Hassan added that on the day she visited him, he had fainted during a court hearing, but that he was not taken to an emergency room. When asked to describe his condition on that day, she told Mondoweiss: “We can call him terminally ill, very very ill.”
“He was really trying to say, please take me seriously,” Dr. Qassem said.
“He had low blood pressure, he had lost half of his weight, and he could barely speak to me. He had difficulty concentrating. He told me he was very weak and that he had never felt this bad in previous strikes. He felt he was going to die.”
Dr. Qasem Hassan, who also practices as a palliative care doctor, said Adnan was speaking to her “like a dying person.”
“He said a few days prior he had bloody vomiting and nonstop vomiting and fainted after that,” she said. “He said he felt he was in the grave, and had visions of his late father and mother. And he kept saying ‘la ilaha illallah,’” the testament of faith that Muslims are supposed to say before they die.
After visiting Adnan on April 23, Dr. Qasem Hassan and PHRI published a report noting a severe deterioration in his health, warning that he faced “imminent death and must be urgently transferred to a hospital for observation.”
Dr. Qasem Hassan was shocked to hear that, despite the clear danger to his life which she had emphasized in her report, Israeli military courts continued to delay Adnan’s scheduled hearings, and on Thursday, April 27, an Israeli military judge denied a third appeal for Adnan’s pretrial release on the basis of his deteriorating health, saying that Adnan “fully understands his actions and where they will lead him. He is the master of his own body.”
The judge also said that he “had not been presented with any medical opinion that Mr. Adnan’s life was in immediate danger,” the New York Times reported, citing court documents.
Dr. Qasem Hassan told Mondoweiss that when she heard the court’s decision and the judge’s claim that he had not been presented with enough medical evidence to prove Adnan’s life was in danger, it confirmed her suspicions that the courts, in collaboration with the Israeli security apparatus, wanted Adnan to die.
“That [court decision] really confirmed my feeling. Not only me or PHRI said his life is in danger. Even IPS doctors said that, and agreed he should be in the hospital,” she said.
Dr. Hassan said that she believed Israeli authorities’ treatment of Khader Adnan was about more than just breaking Adnan. “Every hunger strike like this is so traumatic to the Palestinian people. I think it’s an Israeli policy in order to break the people,” she said.
‘Cruel and inhumane treatment’
While deliberate medical neglect was one of the primary driving forces that led to Adnan’s death, it was not the only one. He was also subjected to physical conditions deliberately meant to cause a further deterioration in his already dire medical condition.
According to his wife and the legal team handling his case, Adnan was being forced to engage in strenuous physical exertion. One example was on the afternoon of April 27, the 82nd day of his hunger strike, when Adnan was forced to walk unreasonably long distances in order to reach the judge.
“He wasn’t able to walk,” Moussa recalled to Mondoweiss. “They forced him to walk, they dragged him. Khader said that he was forced to walk a kilometer.”
Moussa also remembers seeing her husband’s face through video conference following the strenuous walk Adnan was made to walk. “After he told me they made him walk without a wheelchair, I told him to sit down and not move,” Moussa recalled the April 27 court hearing to Mondoweiss.
Almost one week later, Adnan was joining what would be the final court hearing of his life via videoconference. According to his wife, Adnan fainted during the hearing that day as well. “He looked horrifying,” Moussa told Mondoweiss the day after the hearing. “His face was so pale,” she explained. “He fainted, and just like that, the screen went black.”
Dr. Qasem Hassan also told Mondoweiss that the conditions he was being held under were unacceptable given Adnan’s condition, describing them as “torture.”
“First and foremost, it [the prison clinic] is a jail. That’s what it is,” she said.
“He was being held in a cell with a bed and a bathroom. That’s it,” she told Mondoweiss. “He complained that his mattress had bed bugs, and the bugs would bite him.” IPS did not provide Adnan with a new, clean mattress, forcing him to sleep on the floor of his solitary confinement cell throughout his hunger strike.
She added that as he grew weaker, it became increasingly difficult for him to lift himself off the floor to reach the bathroom, where the medical emergency button was located.
“He reported that he fainted off the bed a few times, and no assistance was given to him,” Al-Khatib told Mondoweiss.
Additionally, despite the warnings of imminent risk to his health, and the need for monitoring at a hospital, Adnan was left unmonitored in his prison room, for the most part left chained with shackles to the bed from his hand and leg, according to Al-Khatib.
Dr. Qasem Hassan said that prison guards would enter his room every 30 minutes, loudly opening and closing doors. “He told me he couldn’t sleep because of this, and they were doing it on purpose,” she said. “It was a kind of torture.”
Punishment after death
Adnan’s body remains withheld from his family as of the time of writing. He is now one of a dozen frozen bodies of Palestinian detainees who died inside Israeli military captivity who continue to be denied the right to burial.
“The limits are always being tested,” Bulous explained. “It has been obvious for the past few years that Israel will at some point leave a hunger striker to die to get rid of this strategy of resistance,” she said.
In this sense, withholding Adnan’s body is yet another punitive measure meant to demoralize Palestinians and set an example for what Israel does to hunger strikers.
“Everyone is affected. It’s a personal and collective trauma. All the people, the family, his village, are all in trauma. They don’t know what happened to him, or how he died,” Dr. Qasem Hassan said.
Yet Amany Sarahneh of the Palestinian Prisoners’ Society thinks this won’t change things. “Detainees want to confront, so the issue will not end with Adnan’s death.”
“Although this arrest was not like the others in that it was not administrative detention and there was an indictment list presented,” Al-Khatib told Mondoweiss, “we were pleading not guilty and his trial was still on May 10th, so no sentence was made in his case.” According to Al-Khatib, Adnan was not convicted. With that, withholding Adnan’s body for almost a week without burial represents Israel’s intentional targeting not of Adnan, but the ideas he embodied.
“I admit, I warned Adnan against this hunger strike, I told him we’ll go to trial,” Al-Khatib told Mondoweiss. “But you can’t tell him that, because he had a conviction that all of it was wrong,” Al-Khatib said.
“The policy of Israeli authorities is to break down the morale of the Palestinian people in their struggle for freedom. This time they wanted [Adnan’s death] to happen. They wanted to use his death to break the morale of the people, Dr. Qasem Hassan said.
Yet as Dana Bulous concluded, “even when their freedom is taken away from them in the most absurd way, [Palestinian political detainees] still manage to prove that they are the ones who choose how and where they are free.”
And in choosing to exercise control over his own fate in life and in death, Khader Adnan remained free.
Yumna Patel is the Palestine News Director for Mondoweiss
Mariam Barghouti is the Senior Palestine Correspondent for Mondoweiss