Calls for emergency release of Zhang Zhan, a Chinese journalist detained for reporting on the COVID-19 pandemic in Wuhan, have grown as her family fear she is close to death.

According to The Guardian, at least 163 lawyers and citizens have signed an open letter calling for immediate medical care for Zhang, who has been on a hunger strike for more than a year in protest at her persecution.

Zhang was one of the journalists arrested after reporting on the Wuhan lockdown and the COVID outbreak in early 2020, but she was the first convicted. Her reports challenged Chinese official claims about the pandemic, which the authorities had attempted to cover-up.

Zhang, a former lawyer turned citizen journalist, was sentenced in December last year to four years in jail on charges of disseminating “false information through text, video and other media through the internet media such as WeChat, Twitter and YouTube”, and having “maliciously speculated” during interviews with foreign press, according to the indictment sheet.

In her first arrest last May, she was accused of “picking quarrels and provoking trouble”— an accusation that Chinese authorities often used against dissidents, activists and journalists.

Lawyer Ren Quanniu claimed that the authorities’ severe punishment against Zhang is a possible “retaliation” against citizen journalists trying to cover the pandemic, aimed at sending a warning message to others.

“The virus issue is indeed very sensitive, including where it came from and what is the situation in Wuhan,” said Ren, whose legal license was revoked after representing Zhang and members of the Hong Kong 12.

The former lawyer said that the conviction also demonstrates China’s strict control over journalism, public opinion, and freedom of speech.

“No matter if you are citizen journalists or independent media, things that are so-called ‘sensitive’ and do not conform to the caliber of propaganda are not allowed to be said,” he said. “If you make these things public, you may encounter similar results like Zhang Zhan. This is a warning to others.”

Earlier in November, Zhang was nominated for a Reporters Without Borders (RSF) press freedom award for courage, recognizing her work reporting from Wuhan in the early weeks of the pandemic. She was granted the RSF’s 2021 Press Freedom award on Nov. 18.

Family, friends and legal contacts have said they have tried to get Zhang to end the hunger strike but she could not be convinced. Before her sentencing, Zhang’s lawyer at the time reported she was being restrained and force-fed via a tube, according to The Guardian.

An international campaign is urgently calling for her release on any grounds possible, to save her life.

In their open letter, the lawyers and citizens claimed Zhang was innocent and praised her work in the early period of the outbreak.

“When many people fled Wuhan in fear, Zhang went in alone. This kind of courage is rare,” they wrote. “[This] is behavior a modern government should encourage. It not only contributes to disaster relief, but creates an atmosphere of mutual assistance and friendship … It is unjust to use criminal means to punish Zhang Zhan’s actions, which were not only harmless but helpful.”

The U.S. State Department last week criticized the “arbitrary” detention and called for her immediate and unconditional release.

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