An American jailed in Egypt is facing medical issues that leave him at risk of dying behind bars and after the sudden death this week of former Egyptian President Mohammed Morsi , who was held in the same facility and had similar health trouble, his supporters worry that thats his likely fate unless the Trump administration takes dramatic action.

Mustafa Kassems family has recently been shocked by his frail look, his weight loss, his mental awareness and acuity he doesnt seem as with it as he normally would be, said Praveen Madhiraju, an advocate for Kassem at the nonprofit group Pretrial Rights International. He is back in and out of the hospital ward pretty frequently.

U.S. officials should be trying to quickly secure Kassems release, Madhiraju wrote in an email, saying Kassem had never been involved in the kinds of political activity that he and more than 700 other detainees were accused of in a mass trial last year.

Since Egypts military deposed Morsi, the first freely elected leader in the history of the country and the broader Arab world, in 2013, authorities have arrested Kassem and multiple other U.S. citizens, as well as family members of Americans like green card holders Ola al-Qaradawi and Hosam Khalaf , as part of the worst crackdown in modern Egyptian memory.

The number of Americans jailed in Egypt was at one point close to 20 . But early in the Trump presidency, administration officials pushed for the release of aid worker Aya Hijazi as part of President Donald Trumps bid to say he was putting America and Americans first. Egypt has since also freed a teen named Ahmed Hassan, who turned 18 in an Egyptian jail, and, after public urging from Vice President Mike Pence last year, Ahmed Etiwy , who, like Kassem, was detained during social upheaval and protests following Morsis removal.

Still, inconsistent interest from the top has been painful for Kassem and others whose families have not yet gone public for fear of further angering the Egyptians. Cairo is most likely to act when it hears a concern repeatedly and from throughout the U.S. government, Andrew Miller, a former top State Department official dealing with Egypt, told HuffPost in 2017. Spotty advocacy and relying primarily on private urging the preferred Trump tactic because of the presidents distaste for loud human rights advocacy doesnt work as well.

Kassem and activists had hoped the U.S. might be able to secure his release through a deportation or on humanitarian grounds during the recently ended Islamic month of Ramadan, a traditional time for government clemency , Madhiraju said. Trump aides told him they raised the issue with Egyptian President Abdel-Fattah el-Sissis team when Sissi visited the White House in April. But the month came and went with Kassem, who has diabetes and heart problems, still on a liquid-only hunger strike that he began when he was convicted in September and enduring multiple trips to the hospital.

The U.S. State Department on Thursday said it is sympathetic to Kassems circumstances.

The United States government continues to follow very closely the case of Mustafa Kassem. We continue to raise our concerns about Mr. Kassems health condition with Egyptian prison authorities, and to the highest levels of the Egyptian government, a State Department official told HuffPost in an email.

Morsis shocking collapse during a courtroom appearance on Monday has renewed global concern over how Egypt, a major U.S. ally that receives more than $1 billion in aid each year, is treating the estimated 60,000 people in its prisons. Those who have not already been sentenced under the sharp spike in death sentences since [Sissi] came to power are subject to illness, torture, and inefficient or denied medical care. How many of them are being slowly executed? writer Mona Eltahawy asked in The New York Times on Tuesday.

She noted that the Scorpion wing of the Tora prison, where both Morsi and Kassem were held, has been described as designed to kill inmates.

In Congress, lawmakers from both parties have pressed the Trump and Obama administrations to do more to hold Sissi accountable and change his behavior, particularly in the instances of the jailed Americans. Rep. Peter King (R-N.Y.), who represents Kassems home district, where some of his family still live, has sent the White House multiple letters about the case. He plans to keep up pressure on Egypt and believes U.S. officials are doing what they can, a spokesman told HuffPost.

Kassem, who is 54 and has two children, has said that hes either going to leave there free or in a coffin, Madhiraju said. The powers really with Sissi and we really hope that he exercises some mercy.