Cuban dissident Tomás Núñez Magdariaga, imprisoned on false charges of threats against state police, reached day 50 of his hunger strike on Wednesday.

Relatives say doctors have begun to pressure them to force Núñez to eat in an apparent attempt to prevent his protest from attracting international attention, but they refuse to attempt to change his mind, stating that Magdariaga himself has told them to “respect his decision.” They tell Cuban and Cuban-American outlets that doctors say he is suffering liver failure and is in “critical” condition.

Núñez, a member of the dissident group Patriotic Union of Cuba (UNPACU) and a supporter of the Cuba Decide movement for free elections, was sentenced to a year in prison this year after a Cuban state security agent accused him of threatening him. He began his hunger strike on August 14, insisting that he would not eat until he was allowed to eat in freedom. The agent who accused him, Aldo Rosales Montoya, published a video shortly following Núñez’s sentence admitting to having fabricated the charges against him, which the regime did not allow as admissible evidence for his release.

Leaked photos of Núñez show he is being forced to carry an IV for fluids and support and remains handcuffed within the medical ward at the Santiago de Cuba prison he is being held in.

“The doctor told us, ‘What we want the most from you as family is to tell him to eat,'” neighbor and family friend Yennisey Jiménez told the U.S.-based Cuban outlet Martí Noticias. “The decision to eat is his alone, he is an adult.”

“He always said he was going to eat on the day that they free him, in his house,” she added, noting that he asked “for us to respect his decision.” She noted that he took the dramatic measure after he was “humiliated, crushed” and “prefers to die than to spend another year in prison.”

The pressure on the family appears to be a new tactic from the regime. Last week, Núñez’s niece, Nurvia Núñez Jaime, told Cubanet that she felt the government “has every interest in letting my uncle die” and was actively dismissing appeals for medical attention.

Núñez’s family has appealed to the international community for help, meeting with Vatican officials to urge them to convince the communist Castro regime to release the dissident. They note that he is currently suffering liver failure and doctors cannot predict how much longer he will survive.

The Vatican has traditionally failed to intervene on behalf of pro-democracy Cuban dissidents, even when they are prevented from practicing their Catholic faith. Pope Francis has visited Cuba in the past and had friendly exchanges with dictator Raúl Castro while denying human rights abuses on the island.

The case has, however, attracted the attention of the Organization of American States (OAS). Secretary-General Luis Almagro has repeatedly issued statements demanding the dissident’s release before he dies of starvation.

A blurred photo taken without permission from the state surfaced of Núñez this week, showing that even in a medical ward at over 40 days of a hunger strike, police kept him in handcuffs. According to José Daniel Ferrer, the head of UNPACU, the photo was taken five days ago.

UNPACU members organized a protest calling for Núñez’s release last week in his native Santiago, where he is being held, risking the typically violent arrests the Cuban regime makes against dissidents. In particular, protesters are demanding that the Cuban penal system take Rosales’ confession into account and free Núñez on that exculpatory evidence. To do so would require the regime to admit that lower-ranking security officers like Rosales are forced by their superiors to fabricate such claims against dissidents, weakening a key tactic to silence opposition.

Cuba’s pro-democracy dissident movement has a storied history of using peaceful hunger strikes to call attention to the Castro regime’s atrocities. The most recent dissident to die while on a hunger strike was Orlando Zapata Tamayo, who passed away after refusing to eat in 2010. More recently, internationally acclaimed political activist Guillermo Fariñas completed his 24th hunger strike in 2016. That same year, the Cuban government ended a hunger strike by political prisoner Vladimir Morera Bacallao after over 80 days by force-feeding him after allegedly confusing him with drugs, a practice condemned by international law.

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