CAIRO – As an American imprisoned in Egypt, Mustafa Kassem thought his government would come to his rescue from what he saw as his unjust incarceration. The 54-year-old auto parts dealer viewed his blue U.S. passport as a bulletproof vest that made him untouchable, especially from a government that receives billions in American aid, his relatives have said.

By the time he died on Monday of apparent heart failure, after more than six years in jail with negligent medical care, Kassem’s faith in American power had broken down. Influential U.S. politicians called for his release, but never applying any real pressure, such as the threat of sanctions. Egypt’s authoritarian leader Abdel-Fattah el-Sissi, after all, is a key U.S. ally.

Finally, Kassem saw no choice but to go on a hunger strike in September 2018. In a letter smuggled out of prison at the time, he begged President Trump to help him, noting they were fellow New Yorkers. “I am putting my life in your hands,” wrote the father of two small children.

His death raises serious questions about the ability of the Trump administration to help as many as a half dozen Americans still inside Egyptian jails, the vast majority for flimsy reasons, according to human rights activists – not to mention the thousands of other political detainees experiencing similarly poor conditions. There are more than 300 prisoners currently on hunger strike.

On Tuesday, Egypt’s chief prosecutor ordered an autopsy, saying it had opened up an investigation into Kassem’s death.

Kassem’s death is the latest sign of the extent to which the Sissi government has been emboldened in part by the Trump administration’s policy, at least publicly, of keeping silent on Egypt’s human rights abuses.

Ever since President Donald Trump’s visit to the Middle East in May 2017, where he made clear that human rights would not be a priority for his administration in its relationships with regional allies, abuses have escalated.

“This sad story reflects very poorly on both Egypt and the United States,” tweeted Michael Hanna, a Middle East expert at The Century Foundation. “And the bilateral relationship remains dysfunctional and directionless.”

Today, Sissi has deepened his grip on the country, putting in place the most authoritarian government in Egypt’s modern history, say human rights activists. In an effort to silence dissent and free speech, tens of thousands of activists, journalists and political opponents have been arrested. More than 500 websites deemed critical of the government have been shut down. Extrajudicial killings and forced disappearances of activists are ongoing, as is torture, say human rights groups.

Even as the abuses have grown, Trump has continued to embrace Sissi, even declaring him his “favorite dictator.” He invited Sissi to the White House, which his predecessor Barack Obama never did due largely to Egypt’s poor human rights record. In fact, previous U.S. administrations often used the $1.3 billion in U.S. military aid Egypt receives annually as leverage to press for democratic reforms and freedoms.

“Like 1000s of the country’s political prisoners, he should never have been detained,” tweeted U.S. Sen. Chris Murphy, D-Conn., urging Secretary of State Mike Pompeo to “remind Egypt that military aid is legally tied to releasing prisoners, including at least 6 U.S. citizens.”

The White House did not respond to requests for comment Tuesday.

David Schenker, assistant secretary of state for near-Eastern affairs, told reporters Monday that Kassem’s death was “needless, tragic and avoidable.”

“I will continue to raise our serious concerns about human rights and Americans detained in Egypt at every opportunity,” he said.

Kassem, of Bethpage, New York, was visiting relatives in his native Cairo in the summer of 2013. He was arrested on Aug. 14, 2013, the day Egyptian authorities stormed a sit-in by supporters of the Muslim Brotherhood party in Cairo’s Rabaa al-Adawiya Square, killing as many as 1,000 people, according to human rights groups.

Kassem appears to have been an unintended target: he was arrested at a nearby shopping center, where he had gone to exchange money shortly before his return to the United States, according to the Freedom Initiative, a group that advocates for Egyptian political prisoners.

“After showing his U.S. passport, the soldiers beat and detained him, later transferring him to law enforcement officials who continued this harsh treatment,” said Pretrial Rights International, a nonprofit organization that represented Kassem, on Monday. “A diabetic with a heart condition, prison officials limited access to necessary medications and medical care for the entirety of his detention. He remained in pretrial detention for over five years.”

The late senator John McCain, R-Ariz., asked Trump to urge Egypt to release Kassem. In January 2018, after a visit to Cairo, Vice President Mike Pence told reporters that he had spoken with Sissi about Kassem’s imprisonment, saying that Sissi had “assured” him that “he would give that very serious attention.”

Nevertheless, Kassem was convicted and sentenced to 15 years in jail in a mass trial later in 2018, accused along with 738 other defendants of trying to overthrow the Sissi government. The proceedings, said human rights activists, violated all standards of due and fair process. No evidence directly involving Kassem was ever presented, they said.

On the day of his sentencing Kassem began a “liquid-only hunger strike,” said Pretrial Rights International. Last Thursday, the group said, Kassem “ceased taking liquids and was shortly thereafter transferred to a local hospital, where he passed away” late Monday afternoon.

Senior U.S. officials were well aware of Kassem’s deteriorating state. In June, the Working Group of Egypt, a bipartisan group of diplomats and foreign affairs experts, sent a letter to Pompeo, highlighting the poor medical care of political detainees by Egyptian authorities. They particularly noted that Kassem “is in imminent danger of death.”

The sudden death of former president Mohamed Morsi in June was also a wake up call to assist Kassem and other political detainees.

Morsi, Egypt’s first democratically elected head of state who was ousted in a 2013 military coup engineered by Sissi, was held for six years in prison under exceedingly harsh conditions, human rights activists and his relatives said, including the denial of medical treatment for his diabetes and other illnesses. The Egyptian government had denied the allegations.

In July, Pompeo responded to the letter from the Working Group, saying that “the safety and well-being of U.S. citizens overseas, including those detained, has been a top priority for me.”

He noted that two U.S. citizens detained by Egypt were released under the Trump administration. In 2017, aid worker Aya Hijazi was released after Trump pressed Sissi. And the following year, Ahmed Etiwy, a university student, was freed after Pence urged his release.

But other Americans remain incarcerated on what activists describe as dubious charges. Khaled Hassan, a limousine driver from New York, has been imprisoned since January 2018 on charges that he joined an Islamic State affiliate. Hassan has denied the allegations, saying he was in Egypt to visit relatives when he was picked up by security agents.

While he was in custody, security forces allegedly beat Hassan, delivered electric shocks and raped him twice, Human Rights Watch said. In July, Hassan attempted suicide inside Cairo’s notorious Tora prison, said the group.

Last year, Pennsylvania teacher Reem Mohamed Desouky was jailed after she landed in Cairo to visit relatives. Egyptian authorities have charged Desouky with administering social media accounts deemed critical of the government.

In Washington, Assistant Secretary of State for Near Eastern Affairs David Schenker told reporters on Monday that Kassem’s death was “needless, tragic and avoidable.”

“I will continue to raise our serious concerns about human rights and Americans detained in Egypt at every opportunity,” he said.

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The Washington Post’s Carol Morello in Washington and Kareem Fahim in Istanbul contributed to this report

Egypt says it is investigating death of imprisoned U.S. citizen