MEDICAL REPORT ON THE HEALTH STATE OF THE 5 PRISONERS WHO ARE ON HUNGER STRIKE.
The Report has been made by the doctors of the 5 hunger-strikers and has been given by their lawyers to the Juridical Authorities in Thessaloniki, Greece, on 14th November 2003.

The Report contains: (a) The Results of the physical ex-aminations of the 5 prisoners and their laboratory tests. (b) Their conclusion about the severity of their situation of health. (c) Their appeal to the Juridical Authorities to interfer-ence and for them to secure the life and health of the hunger strikers who are in custody. (A photo of the hand of Simon Chapman that proves his clubbed-finger accompany the Report).


MEDICAL REPORT ON THE HEALTH STATE

OF THE 5 PRISONERS

WHO ARE ON HUNGER STRIKE


1) Simon Chapman, British, born in 1973, theologian

2) Carlos Martin-Martinez, Spanish, born in 1978

3) Fernando Perrez-Goraiz, Spanish, born in 1981

4) Solaiman Dakdouk, Syrian living in Greece, born in 1969, painter

5) Spyros Tsitsas, Greek, born in 1980


For legal use


Thessaloniki, 14 November 2003


The signatories doctors


1) Alexandra Efthimiadou-Griva, internist

2) Kleanthis Grivas, neurologist- psychiatrist, doctor of psychiatry of Aristoteles University of Thessaloniki, Greece

3) Maria- Myrto Griva


Address: Chalkeon 15, 546 31 Thessaloniki

(Tel: 0030-2310-228738, Fax: 0030-2310-250129 & 0030-2310-888039)


Declare the following facts:


A) They have the medical supervision of the five hunger strikers from the first day of their strike (54 days ago for today) and they look after them through all the phases of their ordeal, in the Prison of Diavata were they are kept (as proved by their recording in the respective health files of the prison of Diavata), as well as in hospitals, where they were transported successively because of the worsening of their health (from 03/11/03 until 11/11/03, when they were transferred in the Prisons of Korydalos,Athens).


B) The hunger strikers were arrested in 20 June 2003 (during the protests which took place during the EU Summit in Thessaloniki), ever since they are in custody (for 5 months) and started hunger strike having as their only demand their temporary release (with or without restricting terms) until the day of their trial.


C) Up to date the hunger strikers have fulfilled the following days of complete denial to receive food ( hunger strike):


1. Solaiman DAKDOUK, Syrian, born in 1969, 55 days

2. Carlos MARTIN- MARTINEZ, Spanish, born in 1978, 41 days

3. Fernando PERREZ- GORRAIZ, Spanish, born in 1981, 41 days

4. Simon CHAPMAN, British, born in 1973, 41 days

5. Spyros TSITSAS, Greek, born in 1980, 38 days


As written in the health records of the Prison of Diavata from the signatories doctors, all the persons mentioned above after the first 10 days of hunger strike, began to have typical symptoms of the prolonged lack of food:


GENERAL INSPECTION

- Body weight: Reduction (loss)

- Mobility: Weak
CIRCULATORY SYSTEM

- Blood pressure: Low

- Pulse: Weak

LIMBS

- Limbs: Very cold (upper and lower)

- Plantar reflex: Weak
URINARY SYSTEM

- Oliguria

- Urine: dark-colored and reduction

SKIN

- Dryness

- Atrophy

- Loss of elasticity

- Anemic appearance
DIGESTIVE SYSTEM

- Fur and dryness of the tongue

- Dryness of the gums

- Constipation

GENERAL PHENOMENA

- Feeling of bad general condition

- Loss of physical strength

- Diffused muscular aches

- Muscular weakness

- Dysfunctions in the co-ordination of movements

- Occasional tremor
EYES

- Paleness of palpebral conjuctiva

- Eyes: Penetrate and enlarged

- Direct reflex of pupil: Decreased

- Indirect reflex of pupil: Decreased

- Occasional dysfunction of vision




Besides the above symptoms which characterized ( in different extend for each patient) all five persons, each of them had and personalized problems, mentioned below:


1) Simon Chapman had serious clubbed-finger, which denotes respiratory deficiency and hepatic (liver) tiredness (see the included relative picture).


2) Carlos Martin- Martinez had haemoptysis (spitting of blood), after his transfer at St. Paulʼs Hospital of Thessaloniki


3) Fernando Perrez- Goraiz had great difficulty in excretion of urine (dysuria) and blue disease of lower limbs (cyanosis).


4) Solaiman Dakdouk had strong signs of impairment of the synergic moves of upper and lower limbs, due to muscular resistance.


5) Spyros Tsitsas had diffused thoracic aches and swallowing difficulties


On 31/10/03 the signatories doctors wrote down in the Health Record of the above patients (which is kept in the Prison of Diavata) their warnings about the expected fast recrudescence of their health.


And this recrudescence of health did happen indeed 3 days later (3/11/2003), so that the patients were transferred in different hospitals of Thessaloniki, in the following order:


3-11-2003
Carlos Martin- Martinez
St. Pavlos Hospital

5-11-2003
Fernando Perrez- Gorraiz

Spyros Tsitsas
Papanikolaou Hospital

3rd Clinic of Internal Medicine

Head of Clinic: Dr. Michael Sion

7-11-2003
Solaiman Dadkouk

Simon Chapman

Carlos Martin- Martinez

Fernando Perrez- Gorraiz

Spyros Tsitsas
Ippokrateio Hospital

Surgery Clinic

Head of Clinic:

Dr. George Hatzitheoharis

8-11-2003
All five are

urgently transferred in:
Papanikolaou Hospital

3rd Clinic of Internal Medicine

Head of Clinic: Dr. Michael Sion

11-11-2003
All five are “kidnapped”

at 02:30 in the morning

and transferred

(500 Km farfrom) at the
Hospital of Korydalos Prison, Athens without the authorities informing their families, their lawyers and their personal doctors



During their staying at the above hospitals (3-11-2003 until 11-11-2003), their health became worse, as proved by the disorders of many laboratory values in their blood and biochemical examinations, which took place in at the hospitals.(All the examinations are included in our report file)


CONCLUSION


In our opinion, the continuation of hunger strike


1) Due to total denial of receiving food, includes most certainly the risk of causing irreversible health damages (irreparable damage), because nutrition is the most important biological need


2) Due to denial of receiving water, in addition, will result in certain death.


About the time period required for the above results to occur, we are referred to the teacher of Forensic Medicine,dr Epivatianos, who denotes in his book “Forensic Medicine and Toxicology” (pages 69- 70)


“In total undernourishment, one person can remain alive for a long period of time and, usually, the death becomes from a different and relevant illness ( such as a general infection), because of the reduction of albumins, and mainly of globulins.


In undernourishment, failure of satisfactory function of both exocrine and endocrine glands takes place, due to their atrophy, and therefore appearance of diabetes mellitus occurs, along with acidosis, hypothyreosis, sexual inability and amenorrhea (disruption of menstrual cycle). Additionally various types of vitamin deficiencies appear (Ben-Ben, Pelagra etc)


The time that death will take place due to undernourishment varies and depends on the following factors:

a) The total lack of water or not.

- In total lack of water death occurs within 8 to 10 days

- In receiving only water, deaths occurs after 4 or more weeks

b) The environmental temperature: Low temperature contribute to the faster loss of life, than in higher temperature

c) The age: adults are stronger than children and old people”


Having in mind that all five of the hunger- strikers have low levels of White Blood Cells (denoting weak immune system), they are very liable in inflammations, which can be fatal for their lives.


The prevention of these possibilities depends only on the Juridical Authorities, which can take action in spirit of justice, magnanimity, breadth of views and, above all, humanism.


As doctors we appeal to the Juridical Authorities for their interference and for them to secure the life and health of the hunger strikers who are in custody.



Thessaloniki 14 November 2003


The attendant doctors


Alexandra Efthimiadou-Griva Kleanthis Grivas Maria- Myrto Griva



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158481
continued1

από ... 6:26πμ, Κυριακή 16 Νοεμβρίου 2003
1) Laboratory Test Values



Carlos MARTIN-MARTINEZ



GENERAL HOSPITAL ʽPAPANIKOLAOUʼ OF THESSALONIKI



Á) BIOCHEMICAL RESULTS



ABNORMAL VALUES OF INDICES



TEST
8/11/03
10/11/03
NORMAL VALUES

Glucose
98
76
75-115

Creatinine
0.9
0.8
0.9 - 1.7

Phosphorus
3.4
4.8
3.6 - 4.5

ã-GT
10
9
20 - 75

Albumin
5.6
5.2
3.1 - 5.1

Bilirubin Total
1.36
1.22
0.10 - 1.10

Bilirubin Direct
0.35
0.28
0.01 – 0.3

Bilirubin Indirect
1.01
0.90
0.10 - 0.70

Uric acid
8.5
6.5
2.8 - 7.7

A/G albumin ratio

2.7
1.5 - 2.5

Cl
91

98 - 107




Â) BLOOD TEST RESULTS



ABNORMAL VALUES OF INDICES



Hematocrit
40.3
42.4
43.5 - 53.7

Mean volume of PLT
7.96
7.8
9 – 13

PDW

17.5
9 – 17




C) URINE TEST



ABNORMAL RESULTS OF INDICES



Ketones

15 mg/dL


Blood traces

YES









Note: During a hunger strike, due to the blood condensation which occurs, many of the blood tests values may be “normal” or “almost normal”. Such values are FALSE and NOT RESPECTIVE to the bad health state of the hunger-striker.



158482
continued2

από ... 6:28πμ, Κυριακή 16 Νοεμβρίου 2003
2) Laboratory Test Values



Fernando PERREZ-GORRAIZ



GENERAL HOSPITAL “PAPANIKOLAOU” OF THESSALONIKI



Á) BIOCHEMICAL TESTS



ABNORMAL VALUES OF INDICES



TEST
8/11/03
10/11/03
NORMAL VALUES

Glucose

67
75 -115

Creatinine

1.0
0.9 - 1.7

ã-GT

9
20 - 75

Bilirubin,Total

0.94
0.10 - 1.10

Bilirubin,Indirect

0.80
0.10 - 0.70

LDH

243
120- 230

Cl

95
98 -107




Â) BLOOD TESTS



ABNORMAL VALUES OF INDICES



White Blood Cells
3.35
4.0
4 – 11ê/ìl

Neutrophils

24.3
45 - 85

Lymphocytes

59.9
20 - 45

Monocytes

10.6
2 -10

Mean PLT volume

7.8
9 -13




C) URINE TEST



ABNORMAL VALUES OF INDICES



Ketone

15 mg/dL









Note: During a hunger strike, due to the blood condensation which occurs, many of the blood tests values may be “normal” or “almost normal”. Such values are FALSE and NOT RESPECTIVE to the bad health state of the hunger-striker.



158483
continued3

από ... 6:30πμ, Κυριακή 16 Νοεμβρίου 2003
3) Laboratory Test Values



Solaiman DAKDOUK



ÃGENERAL HOSPITAL “PAPANIKOLAOU” OF THESSALONIKI



Á) BIOCHEMICAL BLOOD TEST



ABNORMAL VALUES OF INDICES



TEST
8/11/03
10/11/03
NORMAL VALUE

Glucose
82
76
75-115

Creatinine
1.0
0.9
0.9 - 1.7

Calcium (Ca)
10.6
9.5
8.5 – 10.5

ã-GT
11
10
20 - 75

Bilirubin, Indirect
0.69
0.80
0.10 - 0.70

HDL
29

35 - 55

LDH
85
106
120 - 230

CPK
41
19
25 - 190

Ô3
1.9

2.1 - 4.7

TSH
0.031

0.4- 4.0

Cl
96

98 - 107




Â) BLOOD TEST



ABNORMAL VALUES OF INDICES



White blood cells
4.3
3.6
4.6 – 10.2

Hematocrite
41.3
45.2
43.5 - 53.7

Mean PLT volume
8.22
8.52
9 – 13




C) URINE TEST



ABNORMAL VALUES OF INDICES

Not observed





Note: During a hunger strike, due to the blood condensation which occurs, many of the blood tests values may be “normal” or “almost normal”. Such values are FALSE and NOT RESPECTIVE to the bad health state of the hunger-striker.



158484
continued4

από ... 6:31πμ, Κυριακή 16 Νοεμβρίου 2003
4) Laboratory Test Values



Simon CHAPMAN



GENERAL HOSPITAL “PAPANIKOLAOU” OF THESSALONIKI



Á) BIOCHEMICAL BLOOD TEST



ABNORMAL VALUES OF INDICES



TEST
8/11/03
10/11/03
NORMAL

VALUES

Glucose
84
48
75-115

SGPT
7
8


ã-GT
10
10
20 – 75



HDL
34

34 – 55

LDH
119
150
120 - 230

Cl
100

98 -107




Â) BLOOD TEST



ABNORMAL VALUES OF INDICES



Hematocrite
39.2
42.8
43.5 -53.7

MCH
31.5
31.2
26 – 32

RDW
15.7
12.1
11- 15




C) URINE TEST



ABNORMAL VALUES OF INDICES



SP
<1.005










Note: During a hunger strike, due to the blood condensation which occurs, many of the blood tests values may be “normal” or “almost normal”. Such values are FALSE and NOT RESPECTIVE to the bad health state of the hunger-striker.



158485
continued5

από ... 6:32πμ, Κυριακή 16 Νοεμβρίου 2003
5) Laboratory Test Values



Spiridon TSITSAS



GENERAL HOSPITAL “ PAPANIKOLAOU” OF THESSALONIKI



Á) BIOCHEMICAL BLOOD TEST



ABNORMAL VALUES OF INDICES



TEST
8/11/03
10/11/03
NORMAL VALUES

Glucose
81
77
75-115

Creatinine
0.9
0.8
0.9 - 1.7

Phosphorus
2.9
4.2
3.6 - 4.5

ã-GT
8
6
20 - 75

Uric Acid
10.2
9.7
2.8 - 7.7

HDL
30

35 - 55

LDH
106
200
120 - 230

Cl
97

98 - 107

T3
1.5

2.1 - 4.7

TSH
0.122

0.4- 4.0




Â) BLOOD TEST



ABNORMAL VALUES OF INDICES



Hematocrite
39.7
45.3
43.5 - 53.7

White Blood Cells
4.06
4.1
4.6 -10.2

Monocytes
15.6
10.3
2 -10 %

Mean PLT volume
7.96
7.8
9 – 13

RDW
15.4
12
11 -15




C) URINE TEST



ABNORMAL VALUES OF INDICES



Ketone
Traces



S.P
<1.005










Note: During a hunger strike, due to the blood condensation which occurs, many of the blood tests values may be “normal” or “almost normal”. Such values are FALSE and NOT RESPECTIVE to the bad health state of the hunger-striker.



158486
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