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It will look like a scene out of a hospital ward.

In a basement room crowded with medical equipment, about 20 people at one time — sick, pregnant, frail and elderly, or on lifesaving medication — will be hooked up to intravenous drips on Wednesday to receive nutrients they need to get through the day.

The unlikely setting will be the main synagogue of the Bobov Hasidic sect, a cavernous house of worship in Borough Park, Brooklyn, that sets up hospital beds and intravenous drips in advance of the Jewish holiday of Yom Kippur. The patients will be frail Orthodox Jews trying to make it, with a little boost, through a day of religiously required fasting.

In recent years, hundreds of frail Jews have turned to intravenous feeding on Yom Kippur, which begins Tuesday at sundown and ends 25 hours later, to avoid violating the prohibition against eating on the holiest days of the Jewish calendar.

“It’s not considered eating if it goes through a vein,” said Yitzchok Fleischer, who inaugurated the program 10 years ago and has seen participation rise sharply. “You’re not supposed to take anything through the mouth or stomach. Anything. Even if you’re allowed to, nobody wants to eat.”

Though some might see the practice as exploiting a religious loophole, it is actually testimony to the lengths some scrupulously Orthodox Jews are willing to go to make sure they do not violate religious guidelines.

Fasting on Yom Kippur is one of those totemic commandments that endure generation after generation when other religious obligations wither away, and even many Jews who do almost nothing Jewish the rest of the year fast. A 2011 study of the New York-area Jewish community sponsored by UJA-Federation of New York found that 61 percent of those surveyed fasted all day on Yom Kippur.

Rabbis have traditionally allowed exceptions for those who are frail or ill, encouraging people to eat rather than gamble with their health. Some Jews ignore their cautions, which explains why Yom Kippur is one of the busiest days of the year for Hatzolah, the volunteer ambulance corps located in many Jewish communities; too many elderly or sick people try imprudently to fast. Yet many of those who are rigorously Orthodox say they feel guilty for breaking the tribal taboo against eating.

Enter Mr. Fleischer, who is active in the Bobov sect’s communal efforts to aid the sick and homebound. Ten years ago, after a frail friend told him that he needed an intravenous feeding to get through the day, Mr. Fleischer, with the help of Maimonides Medical Center nearby, set up virtual clinics at the Bobov synagogue, five other locations and people’s homes. Medical technicians at the clinics administer IV nutrient drips as worshipers lie on 20 hospital cots for half an hour or so each before returning to prayer.

Last year, 200 people used the service. All those participating must orally certify that they have received permission to do so from both a rabbi and a doctor. Healthy Jews are usually excluded.

“Everyone is a difficult case,” Mr. Fleischer said. “It’s not a loophole.”

Although people have long arranged for such drips on their own and there is a similar program in the Hasidic neighborhood of Williamsburg, the scope of Mr. Fleischer’s synagogue-based program is striking.

Mr. Fleischer, a father of nine, said he spoke to three “big rabbis” and all approved the program as complying with Halakha — Jewish law.

“It’s very hard for a person who has always fasted to face the reality of a situation where they have to eat,” he said. “This way they still feel they fasted and Halakhically, they didn’t eat. The mouth is still dry.”

The Bible commands Jews to “afflict your soul” on Yom Kippur as a sign of atonement, and while it does not specifically mention fasting, the commandment has come down to mean acts of repentance like fasting, the wearing of leatherless shoes and abstinence from sexual relations.

Since preservation of life trumps almost any other commandment, rabbis have long held that the frail and those on crucial medications are not only permitted to eat, but also obligated to do so, said Rabbi Menachem Genack, the rabbinical administrator of the Orthodox Union. But because violating a fast is stressful for many observant Jews, some rabbis will, depending on their custom, recommend, for example, eating no more than the size of a large date at intervals of about nine minutes or drinking less than a cheekful of water. Others urge all necessary consumption of food.

So important is the accurate application of Jewish law in this matter that the days before Yom Kippur are a busy time for many rabbinical scholars who answer queries from worried Jews.

Rabbi Gavriel Zinner, a highly respected posek — the Hebrew word for the equivalent of a legal “decider” who applies Jewish law to specific — often ambiguous, cases, sets aside specific times for queries at his synagogue in Borough Park. At his side are Orthodox Jewish doctors who help him with the information he needs to make a determination on breaking the fast for those who need to eat for medical reasons.

Many rabbis have allowed intravenous feeding, even though, according to Web sites on Jewish law, one of the most respected deciders, Rabbi Moshe Feinstein, who died in 1986, ruled that eating was preferable to an intravenous drip, partly because it is forbidden to inflict a wound other than for healing.

Mr. Fleischer was born in Argentina where his parents, immigrants from Poland, settled after World War II. He operates a jewelry booth in the diamond district, on West 47th Street. In his spare time, he is the founder and executive director of the Bikur Cholim D’Bobov, which provides visits to the homebound, financial assistance with medical bills and food packages.

Mr. Fleischer has also organized non-Jewish pediatricians to tend to sick Jewish children on Yom Kippur and other holidays so their parents will not have to wait for hours in hospital emergency rooms.

“Life is not just eating, davening and sleeping,” he said, using the Yiddish word for praying. “You’ve got to do something for other people.”

http://www.nytimes.com/2012/09/25/nyregion/ailing-yom-kippur-fasters-are-helped-by-iv-drips.html?_r=0