Peter Tobin is seriously ill in hospital, chained to his bed and refusing food and medication.
The serial killer looks emaciated in his hospital gown and is understood to be too sick to return to his prison cell.
The 76-year-old is serving a whole life term in jail for the murders of Angelika Kluk, Vicky Hamilton and Dinah McNicol. It is the first picture of him to emerge in 14-years and Tobin, who has cancer, looks to be wasting away, the Sunday Mail reports.
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Tobin is said to be "frail, weak and at death's door", but a source told the paper: "That's been said about him before but he seems to hang on.
"To the unsuspecting eye, he's just a sick old man in hospital but the killer's face is still there."
The monster is suspected of dozens more killings, and families have begged him to tell the truth about what happened to their loved ones before he dies.
Nicola Stork, whose teenage sister Louise Kay disappeared from Eastbourne in 1988 and is strongly believed to be another of Tobin's victims, said: "I don't want Tobin to die because it means we might never know but I've got no sympathy if he's in pain.
"If he dies without giving us information about Louise, then it probably means we'll never know what happened to her or where she is.
"I hope he will confess something or the police can go and speak to him to get it out of him."
And 22-year-old Jessie Earl's parents whose body was found in 1989 after she went missing in 1980, believe Tobin is their daughter's killer.
Tobin is under constant guard in hospital after having emergency surgery following a fall.
Retired detective superintendent David Swindle, who caught Tobin, said: "If there's any humanity there, Tobin will give up the secrets of what happened to these other victims.
"There won't be any sympathy for him being in pain but, if indeed he is dying, it's the least he could do for these families."
Operation Anagram looked at hundreds of unsolved murders with any links to Tobin and eventually narrowed it down to nine.
Dan McNicol, brother of Dinah who was murdered by Tobin in Essex in 1991, said: "He needs to give up these secrets for the sake of his other victims but he'll probably take them to the grave.
"I hope he's suffering in pain."
Asked about Tobin, a Scottish Prison Service spokesperson said: "We don't comment on individuals in our care."
It's not the first time this year that Tobin has become ill.
In April he spent two nights in hospital after becoming unwell and falling in prison.
And in January he was taken to hospital after being found collapsed in his cell.
In 2019 it was revealed he had cancer.
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