23 January 23 2007

Stockwell Day
Minister of Public Safety and Emergency Preparedness Canada

Claudette Deschenes
VP, Enforcement, Canadian Border Services Agency (CBSA)

Re: HEALTH STATUS of Mohammad Mahjoub, Mahmoud Jaballah and Hassan Almrei

Dear Minister Day, Dear Mme. Deschenes,

As health professionals, we are deeply concerned about the health status of Mohammad Mahjoub, Mahmoud Jaballah and Hassan Almrei, who are detained at the Kingston Immigration Holding Centre (KIHC) under security certificates and currently on a liquids-only hunger strike.

As of today (January 22, 2007), Mohammad Mahjoub has been on hunger strike for 59 days, while Mahmoud Jaballah and Hassan Almrei have been on hunger strike for 48 days. During all this time, they have been drinking only orange juice and occasionally clear broth.

We are extremely worried about the fact that KIHC is not medically monitoring the vital signs and general health status of the hunger strikers. This failure to provide appropriate medical monitoring and care could lead to very serious consequences. When a detainee observes a severe voluntary fast, as is the case here, it is absolutely essential that the correctional institution’s medical staff regularly monitor the person’s vital signs (i.e., blood pressure, cardiac and respiratory rate) as well as serum electrolyte levels. Failure to do so violates basic principles of ethical health care.

In an editorial in the prestigious British Medical Journal on health professionals’ obligations in the context of hunger strikes, Dr. Michael Peel wrote: “Conclusions from studies recommend independent medical monitoring after a weight loss of 10% in lean healthy individuals. If the pre-hunger strike weight is unknown, a maximum of 10 days’ hunger strike, or a body mass index of less than 16.5 kg/m2, should be the trigger.” In
the case of the three men currently on hunger strike at the Kingston immigration Holding Centre, the 10-day ‘trigger’ is long past, so there can be no doubt that medical monitoring must be provided immediately.

After hunger strikes varying from 48 to 59 days, all three men are at risk of severe hypotension or hypertension, renal failure, cardiac arrhythmia, heart failure, and a variety of other potentially life-threatening disorders.

We are particularly concerned for the health of Mohammad Mahjoub, who has not received treatment for his hepatitis C since September 2006, and is now on Day 59 of his hunger strike. All three men already had health problems resulting from their lengthy detention without charge (5 to 6 ½ years), often in solitary confinement or other harsh conditions, denied access to a fair trial, with no end in sight, and under constant threat of deportation to countries where they are at risk of torture. Indeed, the Federal Court recognized in December 2006 that there is a serious likelihood that Mohammad Mahjoub would be tortured if returned to Egypt, his country of origin; just as it recognized in the case of Mahmoud Jaballah in an earlier decision. Hassan Almrei is threatened with deportation to Syria, where Canadian citizen Maher Arar experienced horrifying torture. In addition, Mr. Mahjoub and Mr. Jaballah are particularly vulnerable to a variety of health difficulties because they are torture survivors. Finally, all three men have health problems linked to previous hunger strikes, including a 2005 hunger strike that lasted 79
days in the case of Mr. Mahjoub and 73 days in the case of Mr. Almrei. These antecedents increase the likelihood that the hunger strikers may experience life-threatening disorders.

For all these reasons, we believe that it is urgent that all three men undergo a thorough medical examination by a qualified independent physician, as well as being monitored on a daily basis by medical personnel at the Kingston Immigration Holding Centre.

Signed by:

Janet Cleveland, Ph.D., psychologist, Montreal
Marie Munoz, MD, Montreal
Nazila Bettache, MD, Montreal
Scott Weinstein, RN, Montreal
Olivier Sabella, MD, Montreal
Gerald van Gurp, MD, Montreal
Amir Khadir, MD, Montreal
Helen Hudson, Masters candidate, Nursing, Montreal
Marie-Jo Ouimet, MD, Montreal
Pierre Dongier, MD, Montreal
Faiza Majeed, MD, Toronto
Mandeep Dhillon, MD, Vancouver
Valerie Zink, Paramedic, Vancouver
Aida Sadr, MD, Vancouver
Jen Green, ND, Toronto
Thierry Bégin, MD, Montreal
Cathy Crowe, RN, Toronto
Sylvain Couture, MD, Montreal
Misty Malott, MSc(A) Nursing, Montreal
Faiz Ahmad Khan, MD, Montreal
Samir Shaheen-Hussain, MD, Montreal
McGill Nurses for Global Health (MNGH), Montreal
Annie Janvier, MD, Montreal
Ghassan B. Alami, MD, Montreal
Khurram Sher, MD, Montreal
Monika Dutt, MD, Toronto
Diana R. Ahmed, MD, Hamilton
Nicolas Bergeron, MD, Montreal
Bruno Pelletier, MD, Montreal
Laurence J. Kirmayer, MD, Director, Division of Social & Transcultural
Psychiatry, McGill University, Montreal
Marie-Michelle Bellon, MD, Montreal
Renée Joyal, MD, Cowansville
Isabelle Nicolas, MD Cowansville
Vicky Champagne, nurse, Cowansville
Stéphanie Lapointe, nurse, Cowansville
Marc-André Ryan, nurse, Cowansville
Jaswant Guzder, MD, Montreal
Joan Schwartzenberger, Registered Clinical Counsellor, Victoria
Joëlle Nédélec, MD, Montreal
Irene Sarasua, RN, Montreal
Sidney Maynard, MD, Montreal
Jessica Lyons, 3rd Year Collaborative Nursing, Ryerson University, Toronto
Makeda Semret, MD, Montreal
Martine Eloy, nurse, Montreal
Elaine Lafond, MD, Cowansville
Emilie Davoine, MD, Cowansville
C̩cile Rousseau, MD, MSc. РProfessor, Psychiatry Dept., McGill
University, Montreal
Anousheh Machouf, Psychologist, Montreal
Sylvie Laurion, Ph.D., Psychologist, Montreal
Réseau d’intervention pour les personnes ayant subi la violence organisée
(RIVO), Montreal
John Docherty, Coordinator of RIVO, Montreal
Canadian Centre for Victims of Torture, Toronto
Mulugeta Abai, Executive Director of the Canadian Centre for Victims of
Torture, Toronto
Kathy Hardill, RNEC, Nurse Practitioner, Toronto
Chantal Gravel, M.Ps., Psychologist, Montreal
Allison Campbell, registered midwife, Vancouver
Natya Raghavan, MD, Kingston
Will Offley, RN, Vancouver
Anna Cooper, RN, Vancouver
Navdeep Sidhu, MD, Sasketchewan
Megan Oleson, RN, Vancouver
Kyla Ives, Licensed Practical Nurse, Vancouver
Michèle Marois, Infirmière, Gatineau
M. Jane Pritchard, M.D., CCFP, FCFP
Kathryn Leccese, medical student, Montreal
Stephane Voyer, MD, Montreal