What Happens to the Human Body on Hunger Strike?

Two Palestine Action-linked remand prisoners have been on hunger strike for more than 60 days and are at risk of imminent death. 

Heba Muraisi has been refusing food for 68 days and Kamran Ahmed for 61 days. Medical professionals say they are in a critical phase of the hunger strike and could die at any point. 

Muraisi and Ahmed are two of nine detainees in UK prisons held on charges relating to Palestine Action activism who have taken part in what is believed to be the largest rolling hunger strike in the UK since the Maze prison Irish republican hunger strike in 1981, famously led by Bobby Sands.

There is no hard and fast rule on how long someone is able to survive without food. Without food and water, the human body’s maximum survival time is approximately one week. With only water and no food, survival time can extend to up to two to three months (between 60 and 90 days).

The outcome and impact of prolonged hunger striking can affect people differently and depends on factors like age, preexisting medical conditions and state of health before embarking on the hunger strike. Severely restricted food intake over time can shorten a person’s lifespan.

Medical literature on the long-term effects of hunger striking is relatively limited, but studies and reports do exist, along with research from starvation and famine survivors, which informs a clinical consensus.

What happens to the human body during a hunger strike?

Day 1-14

In the first few days of refusing food, the body uses up glucose stored in the liver. Once these stores are gone, the body reaches ‘ketosis’ – the metabolic state where the body is burning fat for energy instead of glucose and the liver is producing the chemical known as ‘ketones’. 

Weight loss tends to be rapid initially due to the loss of water and electrolytes, but begins to slow as the body uses up fat stores. 

Dr Rupa Marya, adjunct professor of land, food and medicine and a research fellow at the School of Medicine at Trinity College Dublin, told Novara Media that by the 14-day mark, fat stores “are pretty much gone”.

Day 14-28

After 14 days of refusing food, the body begins to break down muscle protein for glucose – essentially ‘digesting’ muscle – which also leads to ketone production.

“The digestion of muscle isn’t just our skeletal muscles – the muscles we use to move around in the world,” Dr Marya said, “but also the cardiac muscles or the tiny muscles around the eye. So as degeneration happens, the nervous system also gets affected.” 

Ahmed was hospitalised for the sixth time earlier this week due to ‘shrinkage’ of his heart muscle, chest pain and breathlessness. The heart is a muscle that the body will begin to digest during starvation. 

Dr Jonathan Fluxman, a retired GP with experience of assessing patients in prisons and immigration removal centres, told Novara Media: “We know from studies of people with anorexia that these complications can lead to heart failure and dangerous heart rhythms.”

Essential nutrient deficiency also becomes a more significant factor during this period. Potential thiamine (vitamin B1) deficiency poses a significant risk to the brain, nerves and heart. 

Physical symptoms can include severe weakness, difficulty standing and abdominal pain. Many of the nine prisoners who took part in the hunger strike including Muraisi, Qesser Zuhrah, who paused her strike at 51 days, and Teuta ‘T’ Hoxha, who paused at 58 days, have reported similar symptoms. 

By the fourth week of refusing food, there is likely to be significant muscle and protein loss, weakened bones and an increased risk of permanent damage to organs including the brain, nerves, kidneys, liver and heart. Physical symptoms can include severe vertigo, vision/hearing loss, confusion, bleeding and impaired immune function.

Ahmed has reported intermittent hearing loss, which medical professionals say could indicate nerve damage. 

Day 40+

After 40 days without food, medical professionals agree that a catastrophic event can happen at any time. 

The “ever-present danger” for Muraisi and Ahmed right now is organ failure, Dr Fluxman told Novara Media. “Heba and Kamran could not be at greater risk, they are in the critical, red zone right now. 

“They are well past exhausting their energy and fat stores, their bodies are breaking down muscle and organ tissue to maintain their vital functions.”

Dr Fluxman’s view is shared by Dr Marya, who has experience of treating patients on hunger strike and told Novara Media that the hunger strikes she managed patients on “often stopped in the first early weeks as people started to feel the effects”.  

“Once we get to day 40 – and now day 68 and 61 for two of the hunger strikers – we are in the critical zone for sudden death, for organ failure, for multi-system organ failure. Both of the hunger strikers have been showing concerning signs of these imminent, catastrophic events.”

After more than 40 days without food, lots of lean mass/protein is lost, even for people who would previously have been considered ‘lean-ish’, with an estimated 20% of total body protein lost by day 44 in one case study. 

Cardiovascular instability is common, with symptoms such as a slow heart rate and light headedness. Glucose and ketone problems become increasingly dangerous, especially for people with diabetes or anyone developing severe hypoglycemia.

How does death most commonly occur on hunger strike?

Across medical reviews and clinical guidance, the most common lethal pathways are:

• Dehydration, which can lead to circulatory collapse or renal failure, especially if fluids are restricted. 
• Electrolyte imbalance, which can lead to fatal arrhythmia (heart rhythm problems) both during fasting and during refeeding. 
• Infection/sepsis in advanced malnutrition due to loss of physiologic reserve, which is essentially the body’s potential capacity for recovery that becomes damaged due to starvation.
• Severe neurological complications from vitamin deficiency, usually thiamine. 

What happens if the hunger strikers stop now?

According to historical accounts, some survivors of the 1981 Irish republican hunger strike went on to suffer long-term health problems including digestive, visual, physical and nervous system impairments.

Likewise, even if the Palestine Action-linked hunger strikers stop refusing food now, they could still face “severe long-term consequences to their health”, Dr Fluxman said. These include neurological complications like loss of balance, incoordination and double vision as well as long-term memory loss and concentration difficulties.

“Already, at this stage,” Dr Marya added, “there are likely to be irreversible changes.”  

There’s also the risk of ‘refeeding syndrome’, which can occur when the body tries to metabolise nutrients again. Body chemistry shifts related to electrolyte deficiencies can cause dangerous complications that affect the muscles, lungs, heart and brain. Refeeding syndrome is potentially fatal.

Prisons minister Lord Timpson has ruled out government officials meeting with the hunger strikers or their representatives, and says prisoners are always taken to hospital when needed. 

Dr Marya called the government’s stance so far “a horrendous lack of response” that “shows the brutality of this government”. She also highlighted the government’s failure in its duty under international law to prevent genocide and not assist in or abet gencoide in Gaza, where Israel has killed more than 70,000 people since October 2023. 

Dr Fluxman said: “The bland assurances still being given by the government, that the hunger strikers have access to hospital treatment when necessary, do nothing to address the underlying reasons for the hunger strike, or to mitigate the risks of the hunger strikers dying or suffering serious permanent injury to their health should they pause their hunger strikes.”