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London, United Kingdom – Lawyers and loved ones of hunger strikers linked to the protest group Palestine Action are warning the activists could die in prison as they accuse British prison officials of a lack of care and communication and the justice secretary of ignoring their demands for a meeting.

Of 29 Palestine Action-affiliated remand prisoners held over their alleged involvement in break-ins at the UK subsidiary of the Israeli defence firm Elbit Systems in Bristol and a Royal Air Force (RAF) base in Oxfordshire, eight are on hunger strike across five prisons, including two who have refused food for 44 days. Five have been hospitalised.

“At any moment now, you could receive a phone call to get the most unfortunate news,” Shahmina Alam, whose 28-year-old brother, Kamran Ahmed, joined the protest 36 days ago, told Al Jazeera.

Ahmed returned to Pentonville prison in London on Thursday after having been hospitalised for a second time.

“When he’s in prison, it’s a bit easier because he’s making daily phone calls,” she said. “But when he goes into hospital, the connection cuts because the prison stops us from communicating at all.”

But Alam’s relief when Ahmed called on Thursday was short-lived.

The doctor who treated Ahmed told him that “he will now start to decline” and expected him to be hospitalised for a third time, Alam said.

Having entered prison at a healthy weight for his height, 74kg (163lb) and 180cm (5ft, 11 inches), Ahmed has lost more than 10kg (22lb) and has dangerously high ketone levels.

“He sounded tired,” Alam said. “He’s got ulcerations in his mouth, so when he’s talking, you can tell it’s quite painful for him to talk. Like his mouth sounds like it’s full.

She added: “We’re at a point where it’s very dangerous territory.”

Ahmed, who worked as a car mechanic, was arrested by counterterrorism police in a dawn raid in November 2024, eight months before Palestine Action was proscribed as a “terrorist organisation“. He is charged with aggravated burglary, criminal damage and violent disorder over his alleged involvement in the break-in at the Elbit site months earlier. He will have spent more than 20 months in prison by his trial, which is set for June 2026.

Palestine Action has accused the UK government of complicity in Israeli war crimes in Gaza and said it is “committed to ending global participation in Israel’s genocidal and apartheid regime”.

On December 9, lawyers of the remand prisoners wrote to David Lammy, the justice secretary, requesting an urgent meeting.

“There is the real and increasingly likely potential that young British citizens will die in prison, having never even been convicted of an offence,” the law firm Imran Khan & Partners wrote in the letter seen by Al Jazeera. “As the Secretary of State for Justice, you are in the unique position of being able to address their concerns … before it becomes too late to avoid the death of one or more of our clients.”

Of Ahmed, the firm wrote: “He feels incredibly dizzy, especially when standing. He has suffered from tightness in his chest and shallow breath.”

Alam accused the Prison Service of failing to update the family on Ahmed’s health condition and is worried that he is not being observed closely enough.

At the time of publication, the Ministry of Justice had not responded to Al Jazeera’s request for comment.

The protest is said to be the largest coordinated hunger strike in UK prisons since 1981 when Irish Republican inmates led by Bobby Sands refused food.

The demands of the pro-Palestine hunger strikers include immediate bail, the right to a fair trial and the de-proscription of Palestine Action. They are also calling for all Elbit sites to be closed.

‘Crisis point for activists’

Qesser Zuhrah, 20, and Amu Gib were the first to go on hunger strike 44 days ago. They are accused of involvement in the Elbit and RAF action, respectively.

Zuhrah, who has lost 13 percent of her body weight, recently lost consciousness and was hospitalised, according to reports. Her friends and advising doctors told Middle East Eye that prison authorities have refused to provide information regarding her condition.

Gib has lost more than 10kg and must lie down most of the day because she suffers from exhaustion. She has been offered a wheelchair, her lawyers said, “due to her inability to walk”.

“Reports that Palestine Action activists on hunger strike have been hospitalised due to seriously deteriorating health send chills down the spine,” Amnesty International UK said. “This is crisis point for these activists – prosecutors must drop the allegations of a ‘terrorism connection’ in these cases and end any excessively lengthy pre-trial detention.”

Lammy has yet to respond to the lawyers’ requests for a meeting.

In parliament last week, Speaker Lindsay Hoyle told Labour MP John McDonnell, who has written to Lammy about the hunger strikers, that it was “totally unacceptable” of ministers to fail to respond to correspondence.

Pressure mounted further on Lammy when several days ago, Alam confronted the justice secretary while he was attending a Christmas event in London. Video footage shared on social media shows her presenting a letter to him and explaining her family’s concerns. He can be seen responding, “I don’t know anything about this,” and later asks, “In the UK?”

Their exchange was “deeply concerning”, Alam said.

As fighting continues and access to aid remains restricted, civilians in Sudan are bearing the heaviest cost of a war with no end in sight.

The war between Sudan’s military and the Rapid Support Forces (RSF) paramilitary erupted on April 15, 2023, unleashing a wave of violence that has led to one of the world’s fastest-growing man-made humanitarian crises.

Both sides have been accused of war crimes and crimes against humanity, while the RSF has been implicated in atrocities in Darfur that the United Nations says may amount to genocide.

According to the latest figures from the UN, at least 21.2 million people are facing high levels of acute food insecurity, 9.5 million people are displaced internally, 4.35 million people have fled the country, and 10 million children are out of school with classrooms destroyed, occupied, or unsafe to reach.

Women and girls face heightened risks, with survivors reporting mass executions, torture, rape, sexual abuse, and ransom demands by RSF fighters.

More than 9.5 million people displaced internally

According to the International Organization for Migration (IOM), Sudan is facing the world’s largest humanitarian and displacement crisis, with more than 9.5 million people internally displaced across 10,929 locations in 185 localities, spanning all 18 states of Sudan.

Most of the displaced have sought refuge in South Darfur (1.84 million), North Darfur (1.75 million) and Central Darfur (978,000). More than half, or 51 percent, of those displaced are children.

Even before the current war began, the IOM estimated that more than 2.32 million people had already been displaced in Sudan, mostly in Darfur, due to years of conflict and climate-driven crises.

Since April 2023, an additional 7.25 million people have been displaced within Sudan, including around 2.7 million from Khartoum state, 2 million from South Darfur and a similar number from North Darfur.

More than 4.3 million refugees

In addition to 9.5 million internally displaced people, an estimated 4.34 million are refugees in neighbouring countries, bringing the total number of displaced across Sudan to about 14 million – more than a quarter of the country’s population of 51 million.

Most have sought refuge in Egypt (1.5 million), South Sudan (1.25 million) and Chad (1.2 million). Of those who fled, about 70 percent are Sudanese nationals, while 30 percent are non-Sudanese.

Millions facing emergency levels of hunger

In September 2025, the Integrated Food Security Phase Classification (IPC) estimated that 21.2 million people, 45 percent of Sudan’s population, faced high levels of acute food insecurity. This includes 6.3 million people in Phase 4 or emergency conditions and 375,000 experiencing Phase 5 or famine-levels of hunger.

Famine is the worst level of hunger and occurs when people face severe food shortages, widespread malnutrition and high levels of death due to starvation.

El-Fasher in North Darfur and the besieged town of Kadugli in South Kordofan have been classified as being in famine. Conditions in the besieged nearby town of Dilling are believed to be similarly severe, with supply routes cut off and shortages worsening by the day.

The RSF took the city of el-Fasher, the capital of the state of North Darfur, in October after an 18-month campaign of siege and starvation. The city was the Sudanese army’s last stronghold in the region.

Those who fled el-Fasher, particularly children, are arriving in nearby towns like Tawila in acutely malnourished condition.

The UN Human Rights Office warned that the massacre at the end of the siege forced people to survive on peanut shells and animal feed, while satellite imagery showed bloodstains from mass killings and executions of civilians based on their ethnicity.

Healthcare infrastructure devastated

The war has shattered Sudan’s public infrastructure, including its health system. Fewer than 25 percent of hospitals are operational, leaving millions with no access to medical care amid rising disease outbreaks.

The World Health Organization has documented 200 attacks on health facilities and personnel, with 20 ambulances severely damaged or destroyed.

With healthcare access so limited, cholera has spread across Sudan, causing over 123,000 confirmed cases and more than 3,500 deaths.