The Navy sent extra medical personnel to the Guantanamo detention camp because of a growing hunger strike, and the American Medical Association questioned whether doctors were being asked to violate their ethics by force-feeding prisoners.
The reinforcements arrived at the weekend and included about 40 nurses, specialists and hospital corpsmen, who are trained to provide basic medical care, Army Lieutenant Colonel Samuel House, a spokesman for the detention camp said, said on Monday.
He said 100 of the 166 detainees had joined a hunger strike that began in February to protest their continued detention at the Guantanamo Bay U.S. Naval Base in eastern Cuba. Twenty-one of those had lost enough weight that they were being fed liquid supplements via tubes inserted in their noses and down into their stomachs, House said.
Five were in the hospital for observation but did not have life-threatening conditions, he said.
On Thursday, the president of the American Medical Association sent a letter to U.S. Defense Secretary Chuck Hagel reiterating its long-held position that it is a violation of medical ethics to force-feed mentally competent adults who refuse food and life-saving treatment.
The letter from the AMA's president, Dr. Jeremy Lazarus, stopped short of asking Hagel to halt force-feedings at Guantanamo.
It urged the defense secretary "to address any situation in which a physician may be asked to violate the ethical standards of his or her profession."
Hagel had just returned from a trip to the Middle East and it was unclear whether he had seen the letter, said Pentagon spokesman Army Lieutenant Colonel Todd Breasseale.
Asked if military doctors had raised ethical concerns about being asked to perform force-feedings, Breasseale said, "I can tell you there have been no organized efforts, but I cannot speak for individual physicians.
"I can tell you that we will not allow detainees to harm themselves, and this includes attempts at suicide - including self-induced and peer-pressured starvation to death," he said.
The military has said that some prisoners are pressuring others to join the hunger strike, and that some of those being tube-fed occasionally eat regular meals or voluntarily drink nutritional supplements when they are removed from their cell blocks and are alone with medical personnel.
"It has been the case all along," House said. "Some will eat one meal, and are tube-fed during another, while drinking nutrient at another meal ... Once they are approved (for tube-feeding) they are given the choice."
Military officials say the feedings are done gently, using soft, flexible, lubricated tubes.
Attorney David Remes, who was notified by the military that his Yemeni client, Yasin Ismael, was being tube-fed, gave a starkly different description.
"It can be extremely painful. One of my clients said that it's like having a razor blade go down through your nose and into your throat," Remes said.
He said detainees who resist tube-feedings were forcibly removed from their cells by soldiers in riot gear. "It's really like the way you would treat an animal," he said.
All sides blame the hunger strike on detainee frustration over the Obama administration's failure to carry out its promise to close the detention camp by 2010.