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THE WASHINGTON POST

An Egyptian Jail And The Brutal Toll Of A Hunger Strike

Mohamed Soltan lost 120 pounds during a hunger strike in Egyptian prison, where he landed for protesting against the military regime. The only American prisoner freed since the coup, he's home now. But the physical and pychological effects of food

Mohamed Soltan during his hunger strike in Egypt
Mohamed Soltan during his hunger strike in Egypt
Abigail Hauslohner

FALLS CHURCH — There were times in prison when Mohamed Soltan dreamt about food. He would wake up, his mouth watering or his jaw unconsciously chewing.

At the time, the former political prisoner — now a Falls Church, Va., resident — was starving himself to make the case for his release from an Egyptian jail. It was a far cry from his days as a food-loving Ohio State University student, when he used to invite his friends out to "fine dining" Fridays.

This past Thanksgiving was his first since his release and return to the United States six months ago, and he could eat anything he wanted.

Not that it was much: A 16-month hunger strike is not easy to recover from. Soltan, 28, is still grappling with the trauma, both physically and emotionally, of his imprisonment, including the loss of more than 120 pounds, the harrowing memories of solitary confinement and the painstaking days, weeks and months it has taken his body to recover from not having enough to eat.

"The physical pain goes away," Soltan says now. "The psychological stuff doesn't."

Jailed for speech

Soltan, an Egyptian American who had moved back to Egypt temporarily in 2013, was one of thousands of protesters, former politicians and military critics who were detained after the country's military coup that summer. His father, an Egyptian politician, was also detained and is currently on death row.

Soltan remains the only American citizen to have been freed since the coup, through U.S. diplomacy, and his family credits his hunger strike for drawing attention to his imprisonment. Soltan launched his strike in early 2014, four months after landing in jail, when he realized that his imprisonment — like that of many others — could be indefinite.

Crowded into a cell with about 20 other political prisoners and a smuggled cellphone, he read about the hunger strikes of Irish and Palestinian prisoners, and he researched their methodology. "The one piece of advice was: Don't just start it. Gradually bring your body into it," he says.

So for three months, Soltan weaned himself off food, first cutting out meat and fish, then carbohydrates, and finally dairy.

The human body is hard-wired to survive against staggering odds. Deprived of calories and nutrients, a body will adjust to conserve energy. The metabolic rate slows, as does the heart. The body temperature cools. The brain shrinks.

Andrea Garber, an associate professor of pediatrics at the University of California at San Francisco who has studied starvation and eating disorders, likens it to "a state of hibernation."

Soltan stayed alive throughout the strike by drinking huge volumes of water with added electrolytes and occasional doses of sugar. When he slipped into hypoglycemic comas, prison authorities hooked him up to intravenous drips.

Pushed to the limit

But the longer the food deprivation, the more pronounced the effects — including potentially irreversible organ damage or failure.

For Soltan, the impact was complicated by existing health concerns, including a congenital blood-clotting disorder that requires regular medication, balanced against a careful intake of vitamin K. For more than a year, he regularly slipped in and out of consciousness. Guards pushed him to his court appearances in a wheelchair. And five months into the strike, he suffered a pulmonary embolism in his right lung, which nearly killed him.

Since coming home to Falls Church, where he lives with his sister's family, Soltan's health has stabilized. Steroid injections to his legs helped him regain his ability to walk. The careful reintroduction of food helped him put on 25 pounds. Six months later, he continues to vomit almost every day, unable to hold down most foods. His sense of taste has dulled — something that Garber says could be attributed to a chronic deficiency in some micronutrients such as zinc.

The self-described former foodie no longer savors meals like he used to.

His gastroenterologist — who, like most, has little experience treating former hunger strikers — tells him to focus on keeping food down as long as possible. That way he at least absorbs some of the nutrients.

Soltan and his mother, siblings and sister's family drove to Michigan to spend Thanksgiving with friends and relatives. The day was like others that Soltan remembers from his youth — a gathering of extended family and a heaping portion of turkey, plus some immigrant family fare.

There was traditional Thanksgiving fare — as well as rice drenched in turkey drippings and drizzled with nuts — "because Arabs love rice with everything." There were cousins and in-laws from far afield; family jokes; and football rivalries. For Saturday's game, Soltan wore his Ohio State jersey — a bold move at a family gathering packed with Michigan fans.

Lingering health effects

On one recent night, Soltan's older sister Hanaa drove him to the emergency room after he began experiencing severe chest pain and shortness of breath. The family feared that he was having another pulmonary embolism, and the doctors ran a battery of tests and scans.

But his heart and lungs were fine, and Hanaa concluded is was "stress."

Soltan was held in solitary confinement for the last five months of his imprisonment. The guards took away his writing materials and books. They encouraged him to kill himself, slipping him razors and telling him where to make the cut. And they told him that they were abusing his father. One day, the guards abandoned a dying man in Soltan's cell — leaving him with the lifeless body for half a day.

The fact that his father, numerous friends and many others remain behind bars under Egypt's ruling military regime keeps him awake at night.

"That, to me, is: Do I waste another minute? How much sleep do I really need? And how much time can I be putting into doing something about it?" he says.

A few weeks ago, Soltan testified before Congress about human rights abuses in Egypt. A few days later, the family learned from the relatives of other prisoners that their father had been removed from his cell amid rumors that he was being punished for his son's testimony. Now they have no idea where he is, Soltan and his sister say.

Soltan says he plans to press forward, making the case for the release of his father and thousands of other political prisoners.

Little is known about the long-term physical and psychological effects of an extended hunger strike, particularly when experience is compounded by trauma and continuing stress. Soltan went from 279 pounds to 155 during his strike.

But experts say that an experience with starvation — self-imposed or otherwise — can drastically alter a person's attitude toward food, stimulating a lasting obsession. Garber has seen it in her patients. And researchers saw it in the subjects of the seminal Minnesota Starvation Experiment, developed in the 1940s to treat the deeply malnourished victims of World War II.

For Soltan — a man who once set a small-town record for eating a 24-inch sub and fries in under eight minutes — every bite in his post-prison life has become an exercise in resistance and focus.

In prison, he says, "they wipe the floor with your pride." Prisoners are made to understand that they have no more choices, no will to open the door or to speak to another person.

"So I made a decision to tie my craving of food to freedom," he says. For more than a year, it was the only thing he could control.

He says food still carries that meaning. "The choice is still mine," he says. "I can choose to eat, not to eat, what to eat." But it no longer brings the joy that it once did.

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