TBILISI -- As Mikheil Saakashvili's hunger strike in a Georgian prison nears the one-month mark, authorities in the Black Sea nation are flummoxed by what to do with the stubbornly defiant ex-president as his health deteriorates.
A public tug-of-war has broken out between doctors and government officials over possible hospitalization for the 53-year-old leader of Georgia's 2003 Rose Revolution, who has warned that he is "ready to die" if he is not released.
A team of physicians and other medical experts, including Saakashvili's personal doctor, emerged from an examination on October 19 warning of potentially irreversible damage to his health and urging authorities to relocate him to a fully equipped hospital.
Georgia's justice minister responded by saying a prison infirmary could provide adequate care.
According to his lawyers, Saakashvili, who is not eating food but drinking water, has refused to be moved to a prison hospital.
"Clearly, each passing day is more dangerous than the previous one," Zurab Paghava, a doctor who examined Saakashvili along with the rest of a team of medical experts on October 19 and again on October 23, told RFE/RL's Georgian Service this week.
Paghava, a cardiologist, said the group was unanimous in its conclusion that Saakashvili should be sent to a so-called "Category C" hospital.
"There was no difference of opinion among the members of the council on this issue," he said, adding, "What happened then, I can't tell you."
Paghava has since resigned from the team, citing his own health.
From Leader To Gadfly
Tens of thousands of supporters have demonstrated for Saakashvili's release, and hundreds of supporters have showed up outside the prison facility in Rustavi, in southeastern Georgia, where Saakashvili is being held.
A former lawyer, Saakashvili became a symbol of postcommunist and democratic reform after helping to expunge former Soviet elites in the 2003 revolution and steering widely lauded economic reforms over the next decade.
His popularity slipped amid backbiting and a disastrous five-day war with Russia over two breakaway Georgian regions in 2008.
Saakashvili faces six years in prison over a conviction in absentia on abuse-of-office and other charges that he dismisses as politically motivated. The accusations arose after he and his former party allies lost elections to the Georgian Dream party of billionaire businessman Bidzina Ivanishvili in 2012-13. More charges purportedly stemming from Saakashvili's two terms as president are said to be pending.
Since fleeing Tbilisi in 2013, Saakashvili has been a constant gadfly for Georgian Dream, punctuated by Georgia's withdrawal of the ex-president's citizenship in 2015 after he took a job in exile for the Ukrainian government.
'Ready To Die'
While Saakashvili has become known for his sometimes dramatic antics, his prison hunger strike risks permanent harm to his own health and possible long-lasting damage to Georgia's political reputation.
Saakashvili declared his fast following his detention on October 1 after announcing his plan to return and sneaking into the country -- reportedly in a dairy truck -- to support the opposition in local elections the following day.
Government officials initially rejected reports that Saakashvili was even in Georgia.
One of Tbilisi's major backers, the United States, has said it is following the case "very closely" and urged Georgian authorities "to ensure that Mr. Saakashvili is afforded fair treatment in accordance with Georgian law, and Georgia's international human rights commitments and obligations."
On October 20, Saakashvili's lawyer shared a letter in which he said he was "ready to die" but consented to medical care in order to "preserve my consciousness and ability to work to the end."
But after visiting her son in prison on October 27, Saakashvili's mother, Giuli Alasania, said that he'd changed his mind and is now refusing medical care or resuscitation because prison officials are denying him his right to confidential counsel with lawyers.
"I communicated with him just now, but there is a window between us and we don't have a direct connection," the 74-year-old Alasania said as she left the Rustavi penitentiary where Saakashvili is being kept. "As I understand it, lawyers should have such a [direct] connection as well. This is impossible because the connection with the lawyer should be confidential. How can they do this?"
Saakashvili's doctor and lawyers say he has an underlying blood condition that risks exacerbating the effects of his hunger strike.
The ex-president's doctor, Nikoloz Kipshidze, said Saakashvili was given a blood transfusion on October 22 after a worrying indicator in a blood test. Kipshidze said the procedure "stabilized" Saakashvili's condition but he urged authorities to move him to a civilian hospital because a recurrence "would be difficult to cope with...in a prison hospital."
Finding The Right Hospital
Justice Minister Rati Bregadze said that, if hospitalization were required, Saakashvili would be sent to the N18 penitentiary hospital in Gldani, a district in Tbilisi.
But the office of Georgia's Public Defender, an ombudsman, inspected that facility on October 24 and concluded that it was underequipped and unsuitable for a prisoner in Saakashvili's situation.
"There's an error in the equation," Deputy Public Defender Giorgi Burjanadze told RFE/RL's Georgian Service. "The doctors' recommendations can't be followed in the prison hospital."
Health Minister Ekaterine Tikaradze vowed that authorities would reinspect the N18 infirmary to assess the level of care it can provide.
The medical team concluded after visiting Saakashvili that his case could require magnetic resonance imaging (MRI), CT scans, ultrasounds, and a list of laboratory services and specialists on-site.
But Burjanadze told RFE/RL that N18 was unequipped for so-called duplex ultrasounds, which specifically target blood flow, and that medical staff there who were questioned by inspectors were unaware of whether they even had a resuscitator on the premises.
"'It's planned in the coming days' -- that's how they answered," Burjanadze said.
Saakashvili is a polarizing figure on a political landscape marked by oversize personalities and bitter personal squabbles.
But the eight-year rule of Ivanishvili's Georgian Dream since Saakashvili's ouster has coincided with mounting Western fears of democratic backsliding in Tbilisi.
Major street protests and a parliamentary boycott that required EU mediation followed last year's elections, and the arrest of an opposition leader earlier this year prompted Georgian Dream's own prime minister to resign in outrage.
Georgian Dream outperformed the opposition in that vote, garnering nearly 47 percent overall, but many mayoral and other races -- including in the capital, Tbilisi -- are headed for runoffs on October 30.
It's unclear how much public support Saakashvili still enjoys after years in exile.
His former United National Movement (UNM) won nearly 31 percent of the vote on October 2. And many supporters of the man affectionately known as "Misha" regard him as a political prisoner.
A number of residents told Current Time TV during an informal poll in Tbilisi last week that they thought Saakashvili was being persecuted for his politics.
"But in general, it's a shame that the president is in jail in Georgia today -- a big shame. And this is very bad for the prestige, in general, of our country," one man said.
He added that such things -- including Saakashvili's pledge to remain active in Georgia's politics -- are better left up to the voters.
"Whether he will return or not, it is up to him to decide and the people to choose. Whatever choice people make, so be it."
Prime Minister Irakli Garibashvili has said that Saakashvili will serve his entire six-year sentence in prison. New national elections are expected in Georgia for the parliament and the presidency in 2024.