It doesn’t take bright signs or markers. There is no need for marching and shouting. Violence, too, is unnecessary.

All that’s needed is willpower.

A hunger strike can be one of the strongest forms of protest, not because it is noisy and brash, but because of the human toll it can take. The appearance of a healthy, vibrant person ravaged by hunger can be powerful and motivate leaders to change.

It is with that in mind that Sami Al-Arian began his hunger strike 11 days ago. And it may have been because of that strike, combined with his diabetic condition, that Al-Arian was taken to the hospital Friday night.

Al-Arian, arrested Feb. 20 after being indicted for terrorist activities, spent about two hours at the hospital. When he was returned to his jail cell, he was put under constant surveillance to monitor his health.

Administrators have not revealed information about his hospital visit, leaving speculation as to the exact cause. Al-Arian’s daughter, Leena, said she asked her father about the reason for his hospital visit.

“He didn’t really tell me what happened,” Leena said. “He sounded fine when I spoke to him (Saturday).”

Leena said Al-Arian is still on the hunger strike. Speculation has begun that, if the strike continues too long, officials may seek to intervene.

For decades or longer, numerous governments have experimented with the ways to deal with a hunger strike. Some have allowed protesters to die, while others have conceded, at least in part, to their wishes.

Still others have taken the approach of forcing food into protesters’ systems. While this can now be done through a common intravenous tube, the solution was not always so easy or pleasant. An infamous example of force-feeding occurred in Scotland during the first decade of the twentieth century. Proponents of the Scottish women’s suffrage movement refused to eat in protest and were brutally force-fed through a crude funnel and tube inserted in the mouth.

At least one of the Scottish protesters went on multiple hunger strikes. The tactic has been used as a form of protest by prisoners of war, political idealists and even Russian air controllers in a labor dispute.

But maybe the most comparable to Al-Arian’s case was the world-famous 1981 hunger strike by members of the Irish Republic Army. Imprisoned as terrorists, the prisoners began to starve themselves, reportedly because they wanted to be considered political prisoners. The British government refused to concede, and by the end of the strike, ten people were dead from starvation.

After the first week of Al-Arian’s hunger strike, he had already lost 10 pounds and looked noticeably different. Leena said she and her mother, Nahla, support her father and are proud of him for standing up for his beliefs. She said, however, they are worried.

“We begged him to get off of (the hunger strike),” Leena said. “But he’s very determined.”

Most of the IRA prisoners died between 60 and 65 days after their last meal. John Tibbetts, assistant director for nutrition services at the University of Florida, said, under ideal conditions, people can live about 70 days without food.

Tibbetts said when starvation initially begins, the body feeds off of its sugar stores, and then its protein. Between three days and a week later, the body turns to fat. Tibbetts said the more fat stores a person has, the longer it will take for that person to succumb to hunger.

Tibbetts said when fat begins to burn, the person’s cheeks begin to sink, and the face looks more gaunt. He said, physically, the person will quickly feel sick.

“You would become increasingly more lethargic, especially during the period when you convert from burning sugar. At that point, you feel very rotten, apathetic,” Tibbetts said. “Depending on the hydration status, you may begin to feel a little disoriented. Some people have reported some euphoria, but typically starvation is not recommended as a way to euphoria.”

Now entering his second week of self-starvation, Al-Arian is past those early stages. Tibbetts said much of the timetable for those in a starvation scenario is variable, changing greatly from one person to the next. He said, however, confusion will eventually set in. That will make Al-Arian’s participation in his defense more difficult.

Tibbetts said, also, that for someone who has intentionally chosen starvation, the mental trauma can be difficult.

“If you’re trying to starve yourself on purpose, depression can be an overwhelming emotional aspect,” Tibbetts said. “Communication,(however), would not be an issue. You probably would be able to communicate all the way to the end.”

Al-Arian will not appear in court again until March 24, which would be 32 days after he stopped eating. Tibbetts said, at that point, starvation has taken its toll.

“After 30 days, you probably aren’t doing a lot of activities. You probably are bedridden. Maybe you don’t stay there, (but) you probably spend a majority of the day laying down,” Tibbetts said. “Basically, you’re just existing at that point.”