In June, Ji Sizun received the news that he had won a prestigious human rights distinction, the Cao Shunli Memorial Award, in honour of the veteran Chinese activist who died in 2014 in police custody, after being denied needed medical treatment for months.

It would be a little more than one month until he himself died while under the watch of state security.

Ji, one of China’s most prominent “barefoot lawyers”, self-taught legal advocates, spent most of the last decade in prison in his native Fujian province.

He was in a semi-comatose state when he finished his most recent sentence of four and a half years in late April and was immediately sent to a hospital. On 10 July, two months after leaving prison, Ji, 69, died of unknown causes.

He joins a growing list of imprisoned political activists who have died after being denied adequate medical treatment. His death came three days before the two year anniversary of the death of Chinese Nobel Laureate Liu Xiaobo. Last month, a Uighur writer Nurmuhammad Tohti died after being detained in an internment camp in Xinjiang.

“For human rights defenders in China, prison sentences are increasingly turning into death sentences,” said Yaqiu Wang, China researcher for Human Rights Watch.

People lay white flowers in front of the statue of late Chinese Nobel dissident Liu Xiaobo at a memorial event on his death anniversary outside Tamar Park in Hong Kong Photograph: Philip Fong/AFP/Getty Images

‘A form of torture’

While Chinese detention facilities have long been criticised for their conditions, denying medical treatment to prisoners deemed “sensitive” is becoming increasingly common. Ji suffered intestinal cancer in prison and applications for medical parole were repeatedly refused, according to his lawyers.

“Authorities are deliberately withholding medical treatment as a form of torture to punish, humiliate,” said Frances Eve, deputy director of research at Chinese Human Rights Defenders (CHRD).

“While we have documented deaths of activists and ethnic and religious minorities for years, we are seeing more and more die in recent years under Xi Jinping’s brutal crackdown on civil society.”

Ten people are on a medical watch list maintained by CHRD, including citizen journalists , rights lawyers, one writer and several activists. Uighur intellectual Ilham Tohti, who is serving a life sentence on charges of “splittism”, seeking independence of Xinjiang, is also on the list.

Rights advocates say authorities have been emboldened by largely muted international reaction. Ji’s death has gone mostly unremarked outside of the human rights world.

In Fujian, a coastal province in the southeast, the loss of the longtime advocate known as where Lao Ji, or “Old Ji” has been felt. Ji was one of the country’s “barefoot lawyers”, a term that comes from the “barefoot doctors” of minimal training who worked in rural areas of China during the Mao years. Self-taught lawyers, like Ji, often take on sensitive cases that lead to confrontation with local authorities. Ji operated from a small storefront in Fuzhou, the provincial capital, where former colleagues said his small office was always crowded because he often did not charge his clients and sometimes paid their legal fees himself.

He often worked on behalf of farmers and other rural residents trying to bring their grievances to the government - a centuries old system known as “petitioning”.

“He was always challenging injustice and what was not fair, so these officers wanted to bring him under control,” said Lin Hongnan, one of Ji’s lawyers.

In 2008, when Ji heard officials had opened “protest zones”, for residents to freely demonstrate during the summer Olympics in Beijing, he travelled to the capital to apply for a permit to protest on behalf of his clients. Ji was detained and later sentenced to prison for three years on charges of forging official documents and seals, his first prison sentence.

After being released, instead of keeping a low profile, he went back to work, advocating for the rights of petitioners and butting heads with local authorities.

“Everyone knows the risks are very high and you are likely to be caught. He would rather take the risk. He was not afraid,” said Liu Xiaoyuan, who was previously Ji’s lawyer.

I broke the small bamboo branches on the riverside, but saved one drowning person who struggled in the river. Ji Sizun

Ji helped expose the case of Pandun village where local authorities had seized at least 80% of people’s land. The case was reported in the state-run People’s Daily. Ji was seized by authorities months later and charged with the crime of “picking quarrels and provoking trouble”.

He had also supported pro-democracy protests in Hong Kong. This would be Ji’s second and last time in prison.

“His death is a great loss. There are still many petitioners who want Ji Sizun, the barefoot lawyer, to defend their rights. Now that he is gone, we all grieve,” said Jiang Zhi An, a petitioner Ji had previously helped.

Ji’s death has continued to reverberate. Police detained two friends of Ji on suspicion of writing articles raising questions about the circumstances of his passing. Before his death, doctors told his family his condition had worsened because of internal bleeding but did not give more details.

His family was not given updates or access to his records, and were pressured into signing over power of attorney to authorities, allowing for Ji’s body to be cremated before any investigation could be done. Calls to the Xiangcheng district hospital in Zhangzhou, Ji’s hometown, where Ji died, went unanswered. Provincial officials did not respond to faxed questions.

One of his sisters told the Guardian: “My little brother is already dead. There’s nothing more to talk about.”

Friends and rights advocates disagree, and have called for his work to be remembered. During his first detention after attempting to protest during the 2008 Olympics in Beijing, Ji reportedly kept a diary.

He wrote: “I broke the small bamboo branches on the riverside, but saved one drowning person who struggled in the river. The work was more than enough.”