Five weeks into his hunger strike, family members say Abdulhadi al-Khawaja, one of the best-known human rights activists in Bahrain, is now so weak that he can barely stand.
He started the hunger strike on February 8 to protest his own detention and that of several other activists arrested last April. Al-Khawaja and six others were given life sentences by a military court in what Bahraini and international human rights groups have called an unfair trial.
Al-Khawaja, who suffers from diabetes, has lost more than 14kg since he began his fast. He has started to refuse medical examinations - his last one was almost a week ago - and is now threatening to refuse water as well.
"On Sunday his situation was very bad. My mother said she could barely hear him on the phone," said Maryam al-Khawaja, one of his daughters. "He reached a situation where he could not stand up, even to perform his prayers."
'Very, very serious concerns'
Al-Khawaja is one of 14 activists and political leaders arrested last April. He was taken from his home at night, according to members of his family, who say he was beaten and not allowed to bring his medication with him.
The Bahrain Independent Commission of Inquiry (BICI), the government-sponsored panel which studied the unrest, corroborated some of those claims in its November report, which said the activists arrested in April were seized by masked men late at night.
"In many cases, the arresting units forcefully entered the homes of these individuals, destroyed personal property, including cars, [and] failed either to identify themselves or to inform the arrested individual of the reasons for arrest or to show arrest warrants," the report said in a section which mentioned al-Khawaja by name.
His family says the abuse continued after his arrest. Al-Khawaja was admitted to a military hospital last year with a cracked jaw and skull, among other injuries, and reportedly underwent several surgeries.
The activists were tried by a military court in May, charged with "organising and managing a terrorist group", among other offences. Seven of them, including al-Khawaja, received life sentences, while the rest received shorter jail terms. Those sentences were upheld following an appeal in September.
Amnesty International has described some of the detainees as "prisoners of conscience" convicted simply for attending protests.
"We have very, very serious concerns about his case, and the cases of the other people," said Said Boumedouha, a researcher at Amnesty who has worked extensively on Bahrain.
"The trial before a military court, the allegations of torture that were never investigated ... and there was a lack of any evidence used to prove that these people used violence, or advocated violence."
'His health is not good'
Al-Khawaja is not the first prisoner to go on hunger strike in Bahrain since widespread unrest began in February 2011. Mahdi Abu Deeb, the head of Bahrain's teachers society, went on a three-week hunger strike to protest his detention. But activists say al-Khawaja's is the first open-ended hunger strike in Bahrain.
There is little public information about his condition; the government has kept quiet about his case and has not allowed independent human rights monitors to visit him. An official with the ministry of human rights declined to comment.
Brian Dooley, an activist with Human Rights First who met recently with ministry officials in Manama, said they told him al-Khawaja was not truly on a hunger strike because he was accepting glucose and "other liquids". The ministry also released a statement last week that said al-Khawaja was in stable condition and receiving regular visits from doctors.
He has been receiving doctor's visits, but al-Khawaja's family dismissed the claims about his health - as did his lawyer, Mohammed al-Jishi, who visited his client in jail on Tuesday night.
"His health is not good. He can't walk, and even talking is hard," al-Jishi said. "He's tired. He's not able to stand up; he needs somebody to help him."
Al-Khawaja is also a citizen of Denmark, where he lived in exile for decades, returning to Bahrain after the government announced a general amnesty in 2001. Danish diplomats have visited him in prison several times, and confirmed his deteriorating health.
The Danish foreign minister has demanded his immediate release, and raised the issue earlier this month in a meeting with Bahrain's foreign minister, Khalid al-Khalifa, according to Danish media reports.
"The thing that concerns me the most is refusing to do medical checkups," Maryam al-Khawaja, his daughter, said. "If he enters the critical phase where he needs to go to the hospital, we won't even know."
But the Bahraini government so far has shown little interest in revisiting al-Khawaja's case. His lawyer filed an appeal with the Court of Cassation, Bahrain's highest court, but judges have yet to even set a trial date.
The BICI recommended that a civilian court review all of the convictions handed down after unfair military trials. But most are being reviewed by a committee appointed by the Supreme Judicial Council, a body chaired by the king.
"Abdulhadi thinks there is no legal reason to keep him in jail," al-Jishi said. "He won't stop until they release him, or he will die inside."