The letter addresses the Health and Justice Commissioning Team NHS England
To Whom it May Concern within the Health and Justice Commissioning Team NHS England,
As medical professionals, we are writing to draw your urgent attention to the case of six individuals who have undertaken hunger strikes across prisons in Britain. The individuals concerned in this letter are:
- Qesser Zuhrah (Bronzefield Prison, on remand since 19th November 2024)
- Amu Gardiner-Gibson (Bronzefield Prison, on remand since July 3rd 2025)
- Jon Cink (Bronzefield Prison, on remand since July 3rd 2025)
- Heba Muraisi (New Hall Prison, on remand since 19th November 2024)
- Teuta Hoxha (Peterborough Prison, on remand since 19th November 2024)
- Kamran Ahmed (Pentonville Prison, on remand since 19th November 2024)
We have written separately to the Governor of each prison to highlight our serious concerns regarding their current hunger strikes – which for some, started on 2nd November 2025.
As well as the absence of appropriate safe medical management, to our knowledge these individuals have not yet received the necessary daily clinical monitoring required for patients refusing food and are at risk of sudden electrolyte disturbance, hypoglycaemia and cardiac arrest. In addition, some are already showing signs of this.
After speaking with family, our understanding is that several prisoners conducting hunger strikes have had low blood sugar, for significant periods of time, this constitutes a medical emergency and our understanding is that this is being managed incorrectly.
Many of the prisoners have experienced significant weight loss, including Amy who lost 5 kg within one week and Kamran who upon starting his hunger strike weighed 74 kg and now weighs 68 kg.
They face significant risk of re-feeding syndrome on discontinuation of fasting; managing this complex syndrome requires specialist medical oversight.
Most urgently, there is growing concern for Kamran Ahmed and Lewie Chiaramello. Kamran Ahmed’s health has deteriorated rapidly since 21st November, when he collapsed. On 23rd November, as a result of dangerously low blood sugar levels (3.2), indicating hypoglycemia, the prison administration called an ambulance. The paramedics refused to take him to hospital, claiming that there was nothing they could do for him while he continued to refuse food. On the same day, prison guards put food into his cell, ignoring their own advice on refeeding syndrome, in a blatant violation of their duty of care.
Another prisoner, Lewie Chiaramello (HMP Bristol) has announced that he will be fasting every other day despite being diabetic, a serious risk to his health. The situation has reached a level of urgency that requires the British government to enter into negotiations with the prisoners immediately, so the hunger strike can be ended safely.
As you are aware, the commissioning of prison healthcare has, since 2006, rested with NHS England Health & Justice. We therefore remind you of NHS England’s statutory responsibility to ensure that healthcare services provided within custodial environments are:
– Equivalent to community care (Healthcare Standards, PSI 6/2011);
– Delivered in accordance with the General Medical Council’s Good Medical Practice and the Nursing and Midwifery Council Code;
– Clinically independent, free from non-medical interference;
– Sufficient to meet the obligations of the State under the Human Rights Act 1998 (Articles 2 and 3). We note that:
– PSO 3050 (Management of Prisoners Refusing Food/Fluid) requires daily medical assessments, with hospital transfer where indicated;
– PSI 64/2011 (Safer Custody) states that all agencies involved must act to protect life where identifiable risk exists.
Given that some of these prisoners are soon entering into their fourth week of hunger strike and is now at a critical stage, we insist that NHS England exercises its commissioning oversight to ensure that:
1. All hunger strikers receive immediate and ongoing medical review by suitably qualified clinicians, independent of prison operational staff.
2. Appropriate hospital referral pathways are active, and transfer occurs if clinically indicated.
3. NHS-commissioned healthcare staff are supported and protected in fulfilling their professional and statutory duty of care.
4. A review is conducted without delay into whether current arrangements at HMP Peterborough, Pentonville, Bronzefield and New Hall meet NHS England’s commissioning standards. This situation risks imminent harm to their health and life. Failure to take immediate appropriate action would constitute a breach, not only of professional and commissioning standards, but also raise serious concerns of compliance with the United Kingdom’s human rights obligations. We would be grateful if you could acknowledge receipt of this letter urgently and clarify what urgent steps are being taken by NHS England to ensure that care at HMP Peterborough, HMP Bronzefield, and HMP Pentonville meets required standards.
We, the undersigned, demand that action is taken now to prevent further harm to the health of those that you have a duty of care towards.
Yours sincerely,
Dr Busra Nalbant, Gp
Dr Muhammad Quraishi,
GP Miss Jennifer Wood, Midwife,
Dr Jonathan Fluxman, Retired GP
Dr Judith Atkinson, Retired GP
Mrs Priti Chouhan, Accountant
Mr Abdel Montasir, IG specialist
Ms Joanne Mcewan, Specialist community public
Dr Paul O’Brien, Associate Specialist
Mr Roger Evans, Registered Nurse BsC Hons
Jo Hindley, Retired Midwife
Dr Molly Davey, Anaesthetist
Dr Hugh Hathaway, Core trainee in psychiatry
Mrs Zainah Dulloo, Pharmacist
Dr Rana Najim, GP
Dr Sabina Hashmy, GP
Andee Vaughan, Registered Nurse BA, BSN, RN
Dr Timothy Paris, Psychiatrist
Mr Tanzeel Abid, Biomedical Scientist
Dr Deen Mirza GP / MRCGP
Dr Thanos Tsapas Consultant psychiatrist
Dr Nadine Ebeid Psychiatry CT3
Dr Silvia Yasuda Consultant
Dr Harriet Crook Emergency Medicine Specialist
Ms Jerina Begum
Dr Asif Khapedi GPST2
Dr Huda Mahmoud NHS Consultant
Dr Foyzur Miah MBBS
Ms Jenni Crisp NHS employee
Farhaana Surti MBChB
Dr Saleha Patel GP
Dr Naomi Adelson GP
Dr Rhiannon Mihranian Osborne Medical Doctor
Dr Katharine Fallon MB ChB
Dr David McKelvey Retired GP
Dr Habib Rahman Consultant Cardiologist
Dr Cate Bailey Consultant psychiatrist
Dr Kathrin Thomas Retired GP
Miss Ruqia Gill Registration Nurse
Dr Clare Nickalls, MB Bch university hospital
Marion Neffgen, NHS doctor
Dr Ida Bakar Consultant in Rehabilitation
Doctor Paula Mulvenna, Consultant Clinical Oncologist
Dr Alice Clack, Consultant Obstetrician and Gynaecologist
Dr Mary Hewitt, Retired GP Dr Mary Madden, Anaesthetist
Mr Jesse Fayle, RMN
Dr John Puntis BM(Hons); DM; FRCP;FRCA
Ms Amanda Makin, Retired nurse
Mr Paul Chambers, Charity Co Founder
Dr Miranda Penman Splitt, MBBS MD FRCP
Dr Matthew Lumley, Consultant Haematologist
Dr Daniel Hadley, MRCPsych
Dr James Smith, Emergency Doctor & Lecturer
Ms Mary Light Retired Nurse
Dr Catherine Dyer, Retired
Dr Richard Dyer, Retired GP
Ms Clare Jones, Retired Nurse
Dr Lisa Lobo MBBS
Dr Catherine Dyer, Retired GP
Mrs Patricia Rogers, Administration
Dr Azhar Malik, Retired GP
Dr Juliette Brown, Consultant
Dr Anne Read, Retired consultant psychiatrist
Mr Chris Waites, Dementia Specialist Clinical
Mrs Khadijah Ismailjee, Pharmacist
Michael Foulkes, Consultant Family Psychotherapist
Dr Faiza Malik, MBBS
Mr Roger Evans, Registered Nurse BsC Hons
Mr Roger Evans, Registered Nurse BsC Hons Sarah Alam, GP
Mrs Mubashshira Patel, Pharmacist
Mrs Norma Wilson, Retired Counsellor
Dr Imrana Siddiqui, GP
Dr Samantha Perera, Consultant Psychiatrist
Dr Abbas Tariq, GP
Charlotte Rose, Principal Psychological Therapist in Eating Disorders, Psychotherapist (UKCP), Mental Health Nurse (NMC)
Dr Danny Vincent, GP
Dr Roghieh Dehghan, Dr med univ
Mrs Fahima Shubarna, Senior Healthcare Assistant
Dr Zein Toukan, GP
Sara Rabhi, General practitioner
Mr David Drake, MB ChB (Hons) MSc MRCS
Dr Athif Ilyas, MBBS BSc (Hons) PGDip (Oxon) AICSM MRCPysch
Dr Victoria Holt, MRCGP
Dr Romola Pocock, GP
Dr S Dar, Doctor
Dr Khalid Aziz, Consultant Psychiatrist
Dr Shahan Nizar, Consultant,
Omer Duqeh, Executive Director of Operations
Dr Sara Akhazzan, Resident Doctor
Dr Harshana Sangtani, Doctor
Ms Angela Taylor, Specialist Renal Counsellor
Mr Albert Nti, Registered nurse
Ms Dilly de-Ville, Retired Midwife
Miss María Valero, Hca
Mrs Carol Dean, Admin
Dr Rukyya Hassan. Consultant psychiatrist
Dr Hossam El Sheik, Consultant Gynaecologist
Dr Tennyson Lee, Consultant Psychiatrist
Mr. Andrew Keen, Data Manager/analyst
Rufus George, Deputy Nurse Manager
Dr Abrar Mohamed Mahmoud, Doctor
Mr Wail Afandi, Hospital Doctor
Mr Hussein Khambalia, Consultant Surgeon
Helen Green, Midwife
Dr. Abeer Omar, Professor
Ms Siobhan Hier, Retired health visitor
Dr Ahmad Dowedar, Consultant
Dr Adnan Siddiqui, GP partner MRCGP
Dr Musaad Qurash, Consultant
Dr Danielle James Gayle, Doctor
Dr Faiza Hassan, MBCHb MRCGP
Linnéa Freear, Clinical Scientist
Dr Winona Martell-Brown, Doctor
Dr Nadhya Qureshi, FRCA
Dr Amina Rawat, Consultant Psychiatrist
Dr Lamisha Patel, MBChB MRCGP
Dr Fozia Suleman, MBChB MRCGP