The family of the British-Egyptian political prisoner Alaa Abd el-Fattah say his health has visibly deteriorated due to the escalation of his hunger strike, after being allowed to visit him on Thursday. It was the first time the activist’s mother, Laila Soueif, had been allowed to visit him in nearly a month. Prison authorities repeatedly denied her access last week. “When we saw him today, he was exhausted, weak and vulnerable. He was very, very thin,” his family said in a statement. They said Abd el-Fattah had broken his six-month hunger strike out of a desire to stay alive, but he would resume it if no progress was made regarding his freedom. “There have been no negotiations with the authorities, and no promises have been made. He has been completely in the dark as to what’s happening in the world outside … Alaa came close to death inside, but decided to reach for life. He will have no choice but to resume his hunger strike imminently if there continues to be no real movement on his case,” they said. The visit also brought fresh, graphic details of his increasing mental distress and isolation. Abd el-Fattah is one of Egypt’s most prominent political prisoners, having spent most of the past decade behind bars. Last year, shortly after gaining British citizenship through his mother, the democracy activist was sentenced to a further five years in prison for sharing a social media post about torture. He began a hunger strike in April, consuming just 100 calories a day, which he escalated to forgo all sustenance and then even water on the day that Cop27 began in Sharm el-Sheikh. Abd el-Fattah’s family described how he was pressured to submit to an unusual medical examination two days into his water strike on Tuesday 8 November. At the prison medical centre, Abd el-Fattah refused to be examined unless the authorities acknowledged his hunger and water strike, and his admission to the centre. According to the family, the prison authorities then brought plainclothes security officers and riot police into the medical centre to intimidate him. “As he was being carried out, he ‘lost it’, had a meltdown and promised to kill himself if he was taken back to the cell. When they put him in the cell, he started to smash his head against the wall. He was restrained and tied down. The cell was put on suicide watch,” they said. The family added: “On Wednesday 9 September Alaa smashed his own head against his cell wall, to force the authorities to file an official report on his case and bring in an investigator. He did so repeatedly until he drew blood.” Two days later Abd el-Fattah collapsed in the shower and was given intravenous fluids, electrolytes and a tiny amount of food. “This is how the hunger strike was broken,” said his family. Abd el-Fattah “could see then that his wish for the end was getting the better of him”. He chose to break his hunger and water strike out of concern for the effect it was having on his cellmates, and to wait for his family visit. His family and supporters have grown concerned that the activist’s rapid decline in health comes in the closing days of Cop27 in Egypt, increasing the risk that his case will lose the international spotlight that has accompanied the conference. The UK foreign secretary, James Cleverly, told parliament’s foreign affairs committee this week that he remained “interested” in Abd el-Fattah’s case. The activist’s family and supporters said this marked shift in language and a lack of urgency compared with his previous statements. In a statement on 10 November, the Egyptian public prosecution said Abd el-Fattah had been medically examined and subjected to an inspection of his cell. The statement presented a markedly different picture of Abd el-Fattah’s condition, noting his lack of suffering from any illnesses, but formed the first official recognition of his hunger strike. “The report concluded that his health condition is good and does not require his transfer to the medical centre, with a recommendation for periodic medical follow-up,” it added. The Egyptian foreign minister, Sameh Shoukry, said at the climate conference in Sharm el-Sheikh that the focus should be the diplomatic talks, not Abd el-Fattah’s case. Amnesty International said the news of Abd el-Fattah’s condition demonstrated that the British government should not lose focus on pushing for his immediate release. “It’s yet another reminder that UK ministers have got to start taking Alaa’s fate much more seriously than they’ve been doing up to now,” said Freshta Sharif, Amnesty International UK’s individuals at risk campaign manager. She added: “Rishi Sunak raised Alaa’s case with [Egypt’s president, Abdel Fatah al- Sisi] a week and a half ago, but nothing appears to be happening on the UK side to show that the government is escalating its response.” John Casson, a former British ambassador to Cairo , told BBC Radio 4: “I think it’s time to move from talking and from polite requests to making this the defining issue in our relationship with Egypt. After all, the fundamental duty of the British government is to protect its citizens.” The Guardian approached the Egyptian government for comment.