In frail writing that scrawls across the page, Georgia’s one-time president and opponent of Russian president Vladimir Putin appealed from his sick bed for the European Parliament to intervene to bring him to a hospital he can trust.

Mikheil Saakashvili, a pro-West reformer who came to power after leading a mass protest movement and led Georgia through the 2008 Russo-Georgian War, has been imprisoned since October 2021 on charges that rights groups say are politically motivated.

“Could you please look into the issue of my deteriorating health,” reads the scrawled letter, which was passed to MEPs through a visitor to the clinic where he is kept under guard.

“I need access to a normal hospital in Europe! Would be extremely grateful. The hospital I am now in is a very hostile place,” it reads.

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Georgian authorities deny that Mr Saakashvili (55), is being mistreated and say that he is attempting to evade detention through self-harm. He went on hunger strike for 50 days to protest his detention following his arrest.

But his legal team have circulated a toxicology report that states that “mercury and arsenic” have been detected in his hair and fingernails, and which concludes that he is likely suffering from “heavy metal poisoning”.

This week Ukrainian president Volodymyr Zelenskiy appealed for Mr Saakashvili to be released, holding up photographs of his emaciated state at a press conference and saying he is “being slowly killed”.

The president of fellow EU aspirant state Moldova, Maia Sandu, also called for Mr Saakashvili’s immediate release and transfer for treatment abroad.

“Torturing an opposition leader to death is unacceptable for a country that wants to join the European Union,” she wrote on Twitter.

In comments published in local media, Georgian minister for justice Rati Bregadze dismissed the appeals and challenged accusers to provide “one piece of proof of torture”, calling the allegations “unfair and insulting”. The ministry of justice hung up when called by The Irish Times and had not responded to emailed questions at time of press.

Mr Saakashvili went into exile in Ukraine after his term in office and was granted Ukrainian citizenship. He returned to Georgia unexpectedly in October 2021 and called for mass demonstrations against the government, seen by the opposition as moving into the orbit of Moscow. He was quickly taken into custody, having been convicted in absentia of abuse of power.

Raphaël Glucksmann, a French centre-left MEP who worked for Mr Saakashvili as an adviser, said he believed it to be “credible” that he was poisoned and called for the European Union to make his release a condition of progressing Georgia’s EU membership hopes, and consider sanctions if his detention continues.

“He’s the first post-Soviet leader who dared to oppose the Kremlin. That’s who he is,” Mr Glucksmann said.

“It’s clearly time for us to take action, and to make sure that the former Georgian president is not dying in jail, because it will be such a gift to Putin. He was Putin’s enemy number one. He was a guy who tried to warn us about the threat of the Kremlin. We did not listen, and had we listened, we would not be in this situation with Ukraine.”

In a statement made on behalf of the EU’s chief diplomat Josep Borrell, European commissioner Johannes Hahn said the situation was unclear and that Georgian authorities should consider allowing medical assess to an “independent, uncontested, international organisation”.

“On this point, assessments of his health condition as well as the adequacy of healthcare available in Georgia are being contested by the different sides,” Mr Hahn said.

“Let me assure you that we will continue to closely monitor the developments regarding Mr Saakashvili’s health and we will keep mobilising all our diplomatic efforts in order to avoid any dramatic outcome.”