Images of extremely thin Palestinians released from Israeli custody have circulated widely online, particularly through pro Palestinian accounts, often alongside allegations that Israel deliberately starved them.
But photographs alone cannot establish why somebody lost weight.
Previous examinations of viral imagery have raised separate problems involving images that were altered or could not be independently authenticated. In other cases, serious illnesses have provided important medical context for the physical appearance of individual detainees.
There is another question that receives far less attention.
Were any of the Palestinians appearing severely underweight after Israeli detention voluntarily refusing food?
That question matters because hunger striking is not an obscure phenomenon involving a handful of famous Palestinian prisoners.
Palestinian terrorists, security prisoners and detainees have used voluntary hunger strikes against Israel for more than five decades, sometimes in enormous collective actions. Roughly 3,000 to 3,500 prisoners reportedly participated in a major strike in 2004. In 2012, estimates ranged from approximately 1,600 to more than 2,000 participants, representing a substantial share of the Palestinian prisoner population at the time. Around 1,500 prisoners were widely reported to have joined the major 2017 strike, although Israeli and Palestinian estimates differed.
Historical sources identify more than 20 major collective hunger strikes, with some chronologies putting the number closer to 30.
Across decades, the number of recorded participation events plausibly reaches into the tens of thousands. That does not mean tens of thousands of different prisoners participated, since some individuals went on hunger strike repeatedly.
The scale nevertheless establishes an important point: voluntarily refusing food has been a widespread and recurring Palestinian prisoner tactic, not an exceptional act limited to a few individuals.
And its physical consequences can be extreme.
Some hunger strikes lasted more than 100 days
One of the most extraordinary cases involved Samer Issawi.
Issawi had been released in the 2011 Gilad Shalit prisoner exchange after serving time for terrorism related offenses. Israel later arrested him after accusing him of violating the conditions of his release.
Beginning in August 2012, Issawi launched an extraordinarily long hunger strike.
Contemporary reporting put its duration at approximately 266 days.
But that number needs context.
Issawi was not consuming absolutely nothing for 266 days. Contemporary reporting said he drank water and received intravenous vitamins while refusing solid food.
His strike eventually ended with an agreement that led to his later release.
Other hunger strikers also reached extraordinary durations.
Kayed Fasfous conducted a 131 day hunger strike in 2021 while protesting his administrative detention.
The Palestinian news agency WAFA reported that Fasfous lost approximately 45 kilograms, or 99 pounds.
That weight loss figure was widely repeated but should be treated cautiously. Our research could trace it to WAFA, but not to an independent hospital measurement or named physician who documented his starting and ending weights.
The 131 day strike itself, however, is well documented.
Documented weight loss can be dramatic
Hana Shalabi provides a better sourced example of the physical effects.
During her 2012 hunger strike, Physicians for Human Rights Israel reported that by approximately day 33 she had lost 14 kilograms and was experiencing muscle breakdown and serious physical deterioration.
Her strike ultimately lasted more than 40 days before an agreement was reached under which she was transferred to Gaza.
Khader Adnan experienced even more dramatic proportional weight loss during one of his earlier hunger strikes.
Contemporary reporting said Adnan lost approximately one third of his body weight during a 66 day strike in 2012.
A precise kilogram figure sometimes repeated in later accounts could not be independently verified, so the proportional figure is more defensible.
Khader Adnan repeatedly used hunger strikes
Adnan became perhaps the Palestinian figure most closely associated with the tactic.
He was a prominent figure associated with Palestinian Islamic Jihad, a terrorist organization designated by Israel, the United States and others.
He repeatedly responded to periods of Israeli detention by refusing food.
His final hunger strike began after Israeli forces arrested him on February 5, 2023.
Unlike some earlier periods of administrative detention, Adnan was formally indicted by an Israeli military court on charges including incitement and membership in Palestinian Islamic Jihad. He was awaiting trial.
He nevertheless began another hunger strike.
It continued for approximately 86 or 87 days.
Physicians for Human Rights Israel warned shortly before his death that his condition had become life threatening and sought his transfer to a hospital.
Israeli authorities said Adnan had refused medical examinations and treatment during the strike.
On May 2, 2023, the Israel Prison Service said Adnan was found unconscious in his cell. Medical personnel attempted resuscitation before he was transferred to Assaf Harofeh Hospital, where his death was confirmed.
No publicly released autopsy establishing a precise forensic cause of death was located during our research.
The safest conclusion is therefore that Adnan died after voluntarily continuing an approximately 87 day hunger strike.
What happens when someone refuses food for months?
The human body can survive without normal food for considerably longer than many people assume, particularly when water and some supplementation remain available.
During the early stages of fasting, the body consumes stored glycogen. It then increasingly switches to fat reserves for energy.
Eventually, however, the body begins consuming tissue it needs to survive.
Severe muscle wasting can develop. Blood pressure can fall. Vitamin deficiencies and electrolyte abnormalities can become dangerous. Prolonged starvation can ultimately lead to cardiac complications, organ dysfunction and death.
The timeline differs dramatically between individuals.
Starting body weight matters. So do water, salt, sugar, glucose, vitamins and medical treatment.
That is why a 100 day hunger strike does not necessarily mean 100 days consuming absolutely nothing.
Issawi’s approximately 266 day strike demonstrates the distinction particularly clearly. He refused solid food while reportedly consuming water and receiving intravenous vitamins.
The physical deterioration can nevertheless become enormous and highly visible.
Hunger strikes deliberately create a dilemma for Israel
This is what gives the tactic its political power.
Israel is responsible for the welfare of people in its custody, including convicted terrorists and security detainees. Yet a competent detainee can deliberately refuse food and may also reject medical treatment.
As his condition deteriorates, Israel faces increasing pressure.
Allow the strike to continue and the prisoner may suffer permanent injury or die.
Intervene against his wishes and the state faces serious questions involving bodily autonomy and medical ethics.
Israel historically used force feeding against some Palestinian hunger strikers. Two particularly well documented deaths occurred in 1980, when Rasem Halawah and Ali al Jafari died following force feeding procedures.
In 2015, the Knesset passed a modern law permitting force feeding in extreme circumstances under judicial and medical safeguards.
The Israeli Medical Association opposed the legislation, but Israel’s Supreme Court upheld it in 2016.
Importantly, our research found no confirmed case in which the modern law was actually used to physically force feed a Palestinian hunger striker.
The tactic sometimes produces results
Palestinian prisoners continue using hunger strikes for a simple reason: sometimes they work.
Individual administrative detainees have repeatedly ended prolonged strikes after agreements concerning their detention or eventual release.
Adnan’s 66 day strike in 2012 ended with an agreement concerning his detention.
Muhammad al Qiq ended a 94 day strike in 2016 and was subsequently released.
Fasfous ended his 131 day strike following an agreement concerning his administrative detention.
Other collective strikes have resulted in changes to prison conditions.
Not every strike succeeds. Some ended without achieving their principal demands. Adnan’s final strike ended with his death.
But the history demonstrates how deliberately deteriorating health can become political leverage.
So what do photographs of extremely thin detainees actually prove?
This brings the issue back to the images circulated online.
A photograph can establish that someone looks severely underweight.
It cannot, by itself, establish why.
Was the detainee receiving inadequate food?
Was he suffering from cancer or another serious illness?
Had he voluntarily refused food for weeks or months?
Has the photograph been altered?
Is the photograph authentic but presented without relevant medical or detention history?
Those questions require evidence about the individual person, not assumptions based on appearance.
The history of Palestinian hunger strikes does not prove that every thin Palestinian released from Israeli custody was voluntarily starving himself. Nor does it disprove legitimate allegations concerning conditions inside Israeli prisons. Those claims should be investigated on their own evidence.
But the scale of Palestinian hunger striking makes one conclusion unavoidable.
Voluntary food refusal cannot simply be ignored as a possible explanation.
Thousands of Palestinian prisoners have participated in individual mass hunger strikes. Some strikes lasted more than 100 days. Documented participants have lost substantial amounts of body weight, required hospitalization and continued refusing food despite warnings of potentially catastrophic medical consequences.
Across decades, recorded participation events plausibly number in the tens of thousands, although no reliable count exists for the number of unique individuals involved.
So when an image of an emaciated Palestinian detainee is circulated as proof that Israel deliberately starved that person, the photograph should be the beginning of the investigation, not the end of it.
The relevant question is not simply how thin the person looks.
It is what actually caused the weight loss.
