Jimmy Lai, a former Hong Kong media mogul and outspoken critic of China’s communist regime, has been sentenced to 20 years in prison in a landmark national security case that has drawn international scrutiny as freedoms in the city continue to erode.

Lai, 78, the founder of now-defunct pro-democracy newspaper Apple Daily, was convicted in December last year on two counts of “conspiracy to collude with foreign forces” under the Beijing-imposed national security law and one count of “sedition” under a colonial-era sedition law.

He had already spent more than 1,800 days in confinement before Monday’s sentence. According to his son and lawyer, his health has declined substantially during that time, with conditions including diabetes and heart palpitations.

The three national security judges said Lai’s sentence was increased because he was the “mastermind” and key driving force behind what they described as “persistent” foreign collusion conspiracies, according to a court document.

Judge Esther Toh said 18 years of Lai’s sentence should be served consecutively, on top of the five years and nine months he received in his fraud case in 2022.

Lai’s co-defendants, six former Apple Daily employees and two activists, received jail terms between 6 years and 3 months and 10 years. They are publisher Cheung Kim-hung, associate publisher Chan Pui-man, editor-in-chief Ryan Law, executive editor-in-chief Lam Man-chung, executive editor-in-chief responsible for English news Fung Wai-kong, and editorial writer Yeung Ching-kee. The two activists are Andy Li and Chan Tsz-wah.

In a press conference after Lai’s sentence was announced, Hong Kong’s national security police chief superintendent Steve Li called Lai’s poor health “exaggerated.”

Li added that the sentence was “appropriate” and said the judicial process in the case “represented the finest embodiment of the rule of law in Hong Kong.”

Sebastien Lai said the sentence against his father “signifies the total destruction of the Hong Kong legal system and the end of justice.”

“Sentencing my father to this draconian prison sentence is devastating for our family and life-threatening for my father,” Lai’s son said. “After more than five years of relentlessly persecuting my father, it is time for China to do the right thing and release him before it is too late.”

Lai’s sentence immediately drew condemnation from rights groups.

“The rule of law has been completely shattered in Hong Kong,” Jodie Ginsberg, CEO of the Committee to Protect Journalists, said in a statement.

“Today’s egregious decision is the final nail in the coffin for freedom of the press in Hong Kong. The international community must step up its pressure to free Jimmy Lai if we want press freedom to be respected anywhere in the world.”

Thibaut Bruttin, director general of Reporters Without Borders, said in a statement that Lai’s sentence “underscores the complete collapse of press freedom in Hong Kong and the authorities’ profound contempt for independent journalism.”

“Democracies, such as the UK and the U.S., must stop prioritising the normalisation of relations with China and instead exert pressure on the Chinese regime and Hong Kong authorities to ensure that Jimmy Lai and all other journalists are released from prison,” Bruttin said.

Lord Patten of Barnes, patron of London-based rights group Hong Kong Watch and the last governor of Hong Kong, said in a statement that Lai “now faces the rest of his life behind bars.”

“The UK government has not put sufficient pressure on the PRC to secure his release. This is both a moral and diplomatic failure,” Barnes said, using the acronym of China’s official name, the People’s Republic of China.

Benedict Rogers, co-founder of Hong Kong Watch, called on the United Kingdom, the United States, Canada, Australia, the European Union, and Japan to “act immediately and without delay to press China to release Mr. Lai on grounds of his deteriorating health.”

“This should serve as a warning to all governments, private sector organisations, and individuals who wish to do business in Hong Kong,” Rogers said in a statement. “When the law has been twisted to persecute one individual, it will almost certainly be twisted again. The fate of Mr Lai should be a warning to us all.”

U.S. Sen. Rick Scott (R-Fla.), who serves on the Foreign Relations Committee, said his friend Lai is innocent and his only “crime” was for “daring to think differently from the CCP [Chinese Communist Party] and refusing to use his newspaper to spread CCP propaganda,” according to an X post.

“This sentence is surely a death sentence for someone his age. We will not forget what [Chinese leader] Xi [Jinping] and his thugs have done to Jimmy and so many political prisoners,” Scott added. “ENOUGH IS ENOUGH!”

Lai’s plight was also highlighted in a report by the Congressional-Executive Commission in December last year. The report said that Lai had been held in solitary confinement, “spending over 23 hours a day in his cell and was deprived of independent medical care,” citing his legal team.

The report called on Washington to impose sanctions on Hong Kong’s government officials, prosecutors, judges, police, and foreign financial institutions complicit in the “systematic erosion of Hong Kong’s autonomy and fundamental freedoms” as outlined in two U.S. laws: the Hong Kong Human Rights and Democracy Act and the Hong Kong Autonomy Act.

The commission also called on Congress to pass the Hong Kong Judicial Sanctions Act, which would “mandate stronger sanctions on officials responsible for undermining democracy, human rights, and due process,” according to the report.

Reuters and The Associated Press contributed to this report.