Two young Thai activists accused of insulting the monarchy are in a weak, exhausted condition and experiencing symptoms such as nosebleeds and chest pain after a hunger strike during which they have only sipped water, according to their lawyer and doctors.

Tantawan “Tawan” Tuatulanon, 21, and Orawan “Bam” Phupong, 23, were accused of breaching Thailand’s lese-majesty law after they held up a poster at a shopping mall asking people whether they believed that royal motorcades – which lead to road closures – create trouble for the public. Tantawan faces a second lese-majesty case over a speech she gave on Facebook live.

Thailand has one of the world’s strictest lese-majesty laws, breaches of which carry sentences of between three and 15 years. In 2020, the country was rocked by mass youth-led protests calling for reform of the monarchy, including the scrapping of the lese-majesty law.

Since then, at least 1,888 people have been prosecuted for their political expressions or taking part in protests, including 283 under-18s, according to Thai Lawyers for Human Rights. Among these cases are 215 people accused of breaching the lese-majesty law.

“Not only does the number of [lese-majesty] cases go up but also the age of those convicted or charged seems to go down. It started to involve Thai youth and teenagers. It has become a big concern,” said Pavin Chachavalpongpun, an associate professor at the Center for Southeast Asian Studies, Kyoto University, who has been charged with lese-majesty and lives in exile.

The law needed to be subjected to serious discussion by political parties, which were currently preparing for an election, added Pavin. “You can no longer postpone. It has been put aside for so long by those involved directly in politics,” he said.

Tantawan and Orawan, who are calling for the law to be repealed as well as other changes, including for other activists to be released on bail, began refusing food and water on 18 January. They were hospitalised two days later.

“They are easily tired, very weak, very thin. One of the girls, her lips are not even cracked – there is dead skin peeling off,” said their lawyer, Kunthika Nutcharut.

A statement released by Thammasat University hospital, where they are staying, said Tantawan had still not eaten but was sipping water. She was unable to sleep, had little urine due to dehydration, was experiencing nosebleeds and bleeding gums, and had chest pain and gas in her stomach.

Orawan was weak, had headaches when changing posture, dry lips, chest burn and gas in the stomach. She had received potassium replacement treatment and was sipping water, it said, but had not eaten.

A doctors’ assessment found they both understood the risks attached to their protest, Kunthika said. “[It found] these girls, they know perfectly well the risk of losing their life,” she said, adding that both said they were willing to take this risk if it led to legal and democratic reform.

The two women were motivated by a desire to help other political prisoners, Kunthika added. “They are simple, humble people … They’re not pretentious. It’s very simple for them.”

In a statement issued on Wednesday, the Thai justice ministry said it would consider issues relating to the release of prisoners, such as the use of house arrest in cases where a person was awaiting trial. It was offering support for those who needed to pay bail money through its justice fund, the ministry statement added. The National Human Rights Commission would also produce a report about human rights issues relating to the legal system.

Parit Chiwarak, a prominent activist who previously went on hunger strike while being held in pre-trial detention, said Tantawan and Orawan’s situation was especially difficult because they had been largely refusing water. While respecting their decision, he wrote an open letter this week asking them to reconsider. They should “not expect much humanity in the hearts of the other”, Parit wrote in a post shared on Facebook.

“We need to save our lives and souls for fighting in the long run too,” he said.

Thailand’s pro-democracy protests dwindled in 2021 after the legal crackdown. However, activists point to wider cultural changes as signs of shifting attitudes; while just a few years ago, most people would stand for the royal anthem in cinemas, now it is common for viewers to remain seated.

Rebecca Ratcliffe in Bangkok