London attack: Goodwill and planning got NHS through

The NHS puts lots of effort into planning for a major incident - whether it is a terrorist attack, a cyber-attack, an outbreak of infectious disease or simply a major power cut.
But what the past few months have shown is that the dedication and goodwill of staff play a vital role.
After both the Westminster Bridge and Manchester concert attacks, hospitals ended up turning away doctors, nurses and other staff who were volunteering to come in.
The actions of Dr Malik Ramadhan, divisional director of emergency care and trauma at the Royal London Hospital, where 12 of the London Bridge and Borough Market victims were taken, are a perfect illustration of this.

Multiple casualties

Dr Ramadhan had finished his shift and was cycling home over Tower Bridge at the time of Saturday night's attacks.
"I was completely oblivious," he says, "and as I got to the Old Kent Road a large number of police vehicles came whizzing past, more than I've seen before, and I thought that's a bit unusual.
"Given what's been happening, I thought I had better go back to work."
Dr Ramadhan got back to the hospital and was told it had been put on a major incident alert and to expect multiple casualties.

Clearing beds

"We don't get told specifics," he says.
"We get told something really bad has happened, and we have a plan to prepare for something really bad."
The team started clearing beds, contacting on-call staff and messaging colleagues to see who might be able to come in and help.
"By the time patients arrived, we had fully staffed resuscitation bays to receive each of the patients," Dr Ramadhan says.
"The 12 were all very badly injured. The people who were stabbed had been stabbed with the clear intent to kill."
Dr Ramadhan says the injured were badly shocked - startled to the point where they could not speak.
But hospital staff were prepared.

Staying sober

"People are ready," he says.
"The major trauma system in London has been preparing itself for something to happen."
Dr Ramadhan says off-duty doctors who might normally go out on a Saturday night have been staying sober in case they are needed.
"Doctors like myself who might have been going to Borough after a night in work [are not]," he says.

First decisions

"As Saturday night is testament, we had a lot of people who were completely sober and ready to help the public."
NHS England chief executive Simon Stevens says the weekend's attack once again shows the NHS is "ready and able to respond to such attacks thanks to the professionalism and bravery of our staff".
One of the first decisions senior managers need to make is just how many staff are needed.
An incident on a Saturday night - when staffing is at its lowest - requires many more being brought in than an incident in the middle of the day during the week.

Emergency services

For example, at the time of the attack the Royal London Hospital had just one operating theatre open, but that quickly became five.
But a single hospital is just one part of the jigsaw when it comes to major incidents.
The victims of the London Bridge attack were treated at five hospitals.
They came under the control of the Gold Command system, whereby senior officers from the emergency services take strategic control of incidents from a control centre.
Each hospital has its own contingency plans in place - in fact they were asked to review these just over a week ago after the Manchester attack.
With three terror incidents and a cyber-attack in just three months, the NHS must be primed for any eventuality. 

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The National Front member who fell in love with Calais Jungle migrant

Béatrice Huret stood on a beach on the northern French coast before dawn, watching as her lover headed off across the English Channel in a rickety boat. Would she ever see him again? Had she been taken for a ride, used by a man she met just a few weeks earlier to help him fulfil his dream of a new life in England? Would he drown on the way?
As the boat disappeared over the dark horizon, Béatrice returned to her car, her head full of hope but also full of doubt.
The 45-year-old had just a couple years previously been a card-carrying member of the far-right National Front (FN), and she was the widow of a policeman who she says was racist.
Now here she was helping her migrant lover, Mokhtar, whom she had met in the so-called Jungle migrant camp in Calais, to sneak into Britain.
She recounts the story of how her life changed the day she offered a lift to a teenage migrant in a new book titled Calais Mon Amour.
Béatrice says that before his death from cancer in 2010 her husband had been one of the huge number of police officers deployed in Calais to keep migrants from breaking into the Channel Tunnel terminal or the ferry port, in their bid to get to the UK.
As a policeman he was not legally allowed to join a political party, so he got his wife to sign up instead to Marine Le Pen's FN, which paid her to distribute pamphlets.
She says that, unlike her husband, she was not really racist. But she admits she was worried about "all these foreigners, who seemed so different, and who were getting into France".
Béatrice lived with her teenage son and her mother about 20km (12 miles) from the Jungle, but she had never seen the giant shantytown built of tents and shacks on waste ground on the outskirts of Calais.
On her way home from work one very cold day in 2015, she took pity on a Sudanese boy and agreed to drop him off at the camp, which at its peak last year was home to 10,000 people, most of whom had fled war or poverty in Africa, the Middle East, or Afghanistan.
Then, for the first time, she saw for herself what conditions there were like.
"I felt as though I was in a war zone, it was like a war camp, a refugee camp, and something went 'click' and I said to myself that I just had to help," she says.
Suddenly migrants were no longer just a word, no longer an abstraction.
Béatrice, who works at a centre where young people are trained to become carers, started to bring food and clothing to people in the Jungle, roping in friends and family members to help. Slowly she got to know the camp and its people, ranging "from shepherds to lawyers to surgeons".
Then, in February last year, she laid eyes on Mokhtar, a 34-year-old former teacher who had had to flee his native Iran, where he faced persecution, and was ostracised by his own family for having converted to Christianity.


She met him just at the moment when photos of him, and of several of his compatriots, were being published in newspapers around the world, because they had sewed their lips together in protest at the appalling living conditions in the Jungle.
"I sat down and then he came over and very gently he asked me if I would like a cup of tea, and then he went and made me tea, and it was a bit of a shock. It was love at first sight," she says.
"It was just his look, it was so soft. There they were with their lips sewn up and they ask me, do I want some tea?"


But communication was an obstacle, as Mokhtar spoke no French and she, unlike him, had little English. Their solution was to use Google Translate.
A romance blossomed and Béatrice offered to put up Mokhtar and some of his friends in her house, ignoring advice from her friends that she was making a big mistake.
She was under no illusions about her new lover's goal. Mokhtar had already tried to get to England by hiding in the back of lorries and now he was about to try a change of tack. He and two friends gave Béatrice about 1,000 euros (£980; $1,130) and got her to buy a small boat for them.
On 11 June last year, Béatrice towed it to a beach near Dunkirk, and the trio of migrants, none of whom had been in charge of a boat before, set off at about 04:00 on a perilous journey across the world's busiest shipping channel.
"We dressed them up so they would look like men out on a fishing trip, with fishing rods," she says with a smile.
That was the moment when the whole thing might have ended, when Béatrice hoped for the best but worried that she might have been had, and worried that Mokhtar and his friends might even drown.
That very nearly came to pass, when the boat started taking water around 06:30, as it approached the English coast.
It was terrifying, but with hindsight there was something comic about it.
"The youngest was vomiting from fear, the toughest one was smoking cigarettes and saying 'Well, if you have to die, you have to die, that's life,' and there was Mokhtar scooping out the water and phoning the emergency services at the same time," she says.
The British coastguard sent out a helicopter which eventually spotted them and sent a boat out to the rescue.
The three migrants were later questioned by immigration officers, and after a couple of days Mokhtar was sent to an asylum centre from where he could finally contact his beloved, who had been waiting anxiously on the other side of the Channel.
"He gave his address in Wakefield. I went to see him the next weekend," Béatrice says.
And ever since then she has taken a ferry every second week and driven up to see her lover, who is now in a refugee hostel in Sheffield and who has successfully applied for asylum in the UK. They keep in touch via webcam nearly every night
 
 
So what of the future? The couple have no plans, Béatrice says, noting that "it hurts when you make plans that don't work out".
"If our relationship ends, then so be it [but] I owe Mokhtar a beautiful love story, the most beautiful one of my life."

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The story for her does not end on a purely happy note. Last August she was arrested and charged with people smuggling. She laughs when she speaks of the charge, as for her the idea that she was in it for the money is nothing short of ridiculous.
She was taken into custody at the same police station where her late husband used to work. Released on bail, she was placed under judicial supervision, and has to report to police once a week, as she waits for her trial to begin later this month.
If found guilty, she could in theory be sentenced to 10 years in prison and fined 750,000 euros, though in her case the penalty would probably be less severe.
Béatrice has also been put on the government watchlist of people who are deemed a potential threat to the security of the state. Most people on this list are radical Islamists. This too makes her laugh.
Was it all worth it?
"Yes," she replied without hesitation. "I did it for him. You do anything for love."
Béatrice Huret's book, Calais Mon Amour, is ghost-written by Catherine Siguret

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US warns Beijing on South China Sea islands

The US will not accept China's militarisation of man-made islands in the South China Sea, Defence Secretary James Mattis has warned.
Speaking at a security conference in Singapore, he said such moves undermined regional stability.
China's territorial claims in the resource-rich South China Sea are contested by several nations.
At the same time, Gen Mattis praised Beijing's efforts to restrain North Korea's missile and nuclear activity.
His comments came shortly after the UN Security Council expanded targeted sanctions against North Korea in response to a series of missile tests conducted this year.
The council voted unanimously to back the sanctions after weeks of negotiations between the US and China.
In his speech at the annual Shangri-La Dialogue forum, Gen Mattis said: "We oppose countries militarising artificial islands and enforcing excessive maritime claims.
"We cannot and will not accept unilateral, coercive changes to the status quo."
President Donald Trump and other senior US officials have repeatedly stated that they would protect its interests in the South China Sea, a key shipping route.
During his nomination hearing earlier this year, Secretary of State Rex Tillerson warned that the US was "going to have to send China a clear signal that first the island-building stops, and second your access to those islands also is not going to be allowed."
In response, the Chinese foreign ministry said Beijing would "remain firm to defend its rights in the region".


But in Singapore Gen Mattis also struck a positive note on US-China relations, saying that while competition between the two countries "is bound to occur, conflict is not inevitable".
The biggest question amongst Asian delegates attending the forum has been how much of a role the US will continue to play in this increasingly tense region, the BBC's Karishma Vaswani in Singapore reports.
She adds that Gen Mattis sought to reassure his peers that the US was not turning its back on Asia.


Rival countries have wrangled over territory in the South China Sea for centuries, but tension has steadily increased in recent years.
Its islets and waters are claimed in part or in whole by Taiwan, China, Vietnam, the Philippines, Malaysia and Brunei.
Beijing has been building artificial islands on reefs and carrying out naval patrols in waters also claimed by these other nations.
Although the previous US administration of Barack Obama insisted it was neutral, it spoke out strongly against the island-building and sought to build ties with, and among, the South East Asian nations whose claims overlap those of China.
In July 2016, an international tribunal ruled against Chinese claims, backing a case brought by the Philippines, but Beijing said it would not respect the verdict.
The frictions have sparked concern that the area is becoming a flashpoint with global consequences.

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India launches 'monster' rocket

 

India's space agency has successfully launched its heaviest rocket.
The 640-tonne rocket blasted off from a launching site off the Bay of Bengal in Sriharikota.
As one website put it, "it's been a big day for India". The rocket will reduce the Indian Space Research Organisation's (Isro) reliance on European vehicles to launch heavy satellites.
The coverage of the launch has been euphoric, and often colourful, with websites comparing the rocket to the weight of 200 elephants, or five jumbo jets.

'200 elephants'


Such comparisons highlight the importance of the launch for the country, which is aggressively competing to get a bigger share of the global commercial satellite launch market.
India has so far relied on other countries to send heavy satellites into space, which is expensive and a drain on Isro's budget.
The GSLV Mark III can carry put a payload weighing more than three tonnes into the high altitude orbit occupied by the spacecraft that relay TV, telephone calls and broadband connections.
But it's far from being the world's heaviest rocket because Nasa's Saturn V, which was used between 1967 and 1973, still holds the record at 2,676 tonnes when fully fuelled for lift-off - or about 400 fully grown elephants.


The NDTV website says the rocket is as heavy as five Jumbo jets. And the weight matters because communication satellites are quite heavy.
Experts say the rocket gives India more flexibility in launching different kinds of satellites.
"We were able to send [satellites weighing] up to two tonnes previously. This is a double quantum jump for India," Ajay Lele from the Institute for Defence Studies and Analyses told the AFP news agency.


Isro hopes hopes that the rocket, called the "monster" by one newspaper, will be able to carry an astronaut to space by 2024.
India wants to become the fourth country after the US, China and Russia to send a person into space.
Experts say the successful launch will give impetus to India's indigenous space programme.
launch follows Isro's other recent achievements, including a mission to Mars, and the launch of more than 100 satellites in a single mission earlier in the year.

Taller than Statue of Liberty

In the spirit of finding fun facts, the BBC also did some research on the height of the rocket and found that it's taller than the Statue of Liberty.
The rocket is 43m (141ft) tall, while the statue stands at 33.83m, minus the pedestal foundation.

Cartoons by the BBC's Kirtish Bhat

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The countries that cane their convicts

wo men are due to be caned in public after they were caught in bed together in Aceh, Indonesia.

The men will each receive 85 lashes in public, as punishment under the strict Islamic laws used in Aceh.
It is the only Indonesian province where Sharia is in force. According to human rights campaign group Amnesty International, 108 people were punished for various offences in 2015.
Their offences ranged from gambling to alcohol, adultery and public displays of intimacy outside of marriage.
Pictures of these public punishments - designed to humiliate as much as to injure - show people being led onto a raised platform, and made to kneel or stand as a hooded man beats them with a long, thin cane while a large crowd watches.
Caning is considered so barbaric that Amnesty says it could be considered akin to torture.
But flogging as a punishment for transgressions in countries where Islamic laws are followed is relatively common.
In Sudan, women can be flogged for dressing "indecently". In Saudi Arabia, a woman driving a car can be enough to warrant the sentence. In Iran, attending a party with both men and women can end with being whipped.


One woman flogged for doing just that described on the Iranian Facebook page My Stealthy Freedoms how she was led into a room in shackles and beaten by a woman.
"With the impact of the first lash, I jumped out of my [seat] uncontrollably," the woman wrote. "I was so shocked that even my tears would not drop. I wanted to scream, but I could not even control my voice."
But probably the most famous case in recent years is that of Raif Badawi, a Saudi blogger sentenced to 1,000 lashes and 10 years in prison for "insulting Islam" online.
So far, authorities have only carried out the first 50 lashes. The public outcry appears to have had some success in halting the sentence, but it still hangs over him.
In the Maldives, where Sharia law is mixed with English common law, flogging is also legal punishment, most commonly used on those convicted of having extramarital sex. The majority of cases are women.
Caning is also used as a punishment in Malaysia, Singapore and Brunei, a legacy of British colonial rule in the 19th Century.
Unlike the public floggings in Aceh, however, these punishments take place behind closed doors, with the accused tied to specially constructed frames and carried out with a doctor in attendance.

Its use is relatively widespread: in Singapore 2,203 people were caned in 2012, including 1,070 foreigners, the US State Department said.
Since 2010, at least three Europeans have been sentenced to be caned for vandalism, including Swiss software consultant Oliver Fricker, who spray-painted graffiti on a train.
But the numbers pale in comparison to Malaysia.
In 2010, Amnesty International released a report saying some 10,000 prisoners and 6,000 refugees were being caned each year, punishment for more than 60 crimes - including drug-related and sexual offences, as well as migration violation

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What to expect at Bill Cosby sex assault trial

US comedian and actor Bill Cosby is to go on trial for sexual assault in Pennsylvania later in a case that is expected to last about two weeks.
Former University employee Andrea Constand alleges the 79-year-old drugged and molested her in 2004.
Mr Cosby says he is innocent and the encounter was consensual.
It is being seen as the biggest US celebrity trial since former American football player OJ Simpson's murder trial in 1995.
Several of Mr Cosby's co-stars from the 1984-1992 sitcom The Cosby Show are expected to attend the trial in Norristown outside Philadelphia, along with more than 100 journalists. Broadcasters and photographers are expected to camp outside.

What is he accused of?

Mr Cosby faces three counts of aggravated indecent assault. Each count carries a maximum sentence of 10 years and a fine of up to $25,000 (£19,500).
In 2004 Ms Constand was 31 when she visited Cosby's home seeking career advice after befriending him through Temple University in Philadelphia, where he served on the board of trustees.
She said Cosby gave her three blue pills which made her legs feel "like jelly" and that he then began to touch her inappropriately.
In 2006, the comedian settled with Ms Constand after providing an undisclosed cash sum to her.


At least 50 women have accused Mr Cosby of sexual assault, but he only faces charges in Ms Constand's case because of statutes of limitations.

What is the evidence against him?

Prosecutors are expected to use the testimony of Ms Constand as well as that of another woman, known as Kacey, who says she was assaulted by him in the 1990s.
They are also expected to refer to Mr Cosby's own admission in 2005 that he had used drugs as part of his efforts to have sex with women. 

The drugs, called Quaaludes, are a sedative that was widely used recreationally in the US in the 1970s.
However Judge Steven O'Neill has ruled that the court will not hear about the 2006 civil case. Neither will jurors hear from Mr Cosby's many other accusers.

What is Mr Cosby's defence?

Mr Cosby says his encounter with Ms Constand was consensual.
He also says he offered women drugs as a way to encourage them to relax rather than a way to render them helpless.


On the night of the alleged sex assault, Mr Cosby says he gave Ms Constand some Benadryl, an anti-allergy medication that can cause drowsiness, because she appeared stressed.
Mr Cosby's lawyers are expected to ask Ms Constand why she returned to Mr Cosby's house after she said he had made previous unwanted sexual advances on her.
They may also question why the case is being brought now, more than 10 years after a previous district attorney decided there was not enough evidence to go to trial.

Will he testify?

No - Mr Cosby has said he will not testify and last month told Sirius-XM radio that he feared prosecution lawyers could twist his words on the stand.
"When you have to deal with examination, cross-examination, et cetera, et cetera, more than two sides to every story - sometimes it's four or five," he said.
He has also speculated that some of the allegations against him could be motivated by racism.

Who is on the jury?

The jury is made up of seven men and five women. They include two black people and 10 white people, the New York Times reported.
The jurors are from the Pittsburgh area, 300 miles to the west of the court in Norristown, because Mr Cosby's defence team argued that jurors there could have been affected by pre-trial publicity.
The jurors will be kept away from media reports for the duration of the trial.

Why is Bill Cosby important?

Mr Cosby is best known for his role as the father in the television hit The Cosby Show, which was a huge hit in the US and around the globe.
At one point he was the highest-paid actor in the US.


He was born in Philadelphia and started his career as a stand-up comedian in 1962, debuting on NBC's The Tonight Show in 1963.
In 1965, he became the first black actor to star in a drama series in the US, in the espionage show I Spy. He earned three consecutive best actor Emmys for his role, at a time of high race tensions in the US.
In 2013 he did a national stand-up tour and received rave reviews. After that, several women began to come forward with allegations of sexual assault, some going back nearly 30 years.

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Drug shrinks ovarian tumours in early trial

A new targeted treatment for ovarian cancer has shown "very promising" results in women in the advanced stages of the disease.
It shrank tumours in about half of women who took part in a small trial.
Researchers had only been testing the drug to see if it was safe for humans to take, but found it had an almost instant clinical effect.
It is hoped the drug could help women who have stopped responding to all other currently available treatments.
So far, it has only been tested in 15 women, and the researchers say it may not be safe to take for more than a few months.
However, ovarian cancer is a difficult disease to treat, and the prognosis in the advanced stages is very poor.
Marianne Heath, 68, one of the patients who received the drug, said: "I had no other treatment choices, so I felt this was my only option.
"I just want to keep going so I can keep the tumours at a level where I can enjoy my life. It isn't a cure, but it is life extension for me."
Marianne had treatment over six months, and the drug shrak all three tumours in her body, taking away much of the pain she was experiencing.
One tumour - in her back - has started growing again since she stopped the treatment in January, and she is undergoing radiotherapy for that, but the others are stable.
The researchers, from the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust in London, wanted to establish whether the drug, known in the study as ONX-0801, was safe, so they tested it on a small number of patients.
But they found it significantly shrank tumours in seven of the 15 patients who took the drug - all seven carrying a particular molecule that the drug was specifically designed to target.
ONX-0801 is the first in a new class of drugs which work by mimicking the ability of folic acid selectively to latch on to cancer cells, while leaving healthy tissue alone, thus reducing the side-effects often seen with traditional chemotherapy, such as infections, diarrhoea, nerve damage and hair loss.
Once locked on to a cancer cell, the drug disrupts its chemistry by blocking the action of a key molecule, causing widespread DNA damage and cell death.
The researchers, who hope to carry out bigger clinical trials as soon as possible, have also developed a test that can detect which women are most likely to benefit from the treatment.
Study leader Dr Udai Banerji said: "The results we have seen in this trial are very promising. It is rare to see such clear evidence of reproducible responses in these early stages of drug development.
"The beauty of this particular drug is that it is targeted to the cancer cell. This means there are fewer side-effects, making it a kinder treatment for ovarian cancer patients.
"It's early days of course, but I'm keen to see this treatment assessed in later-stage clinical trials as soon as possible."
Dr Catherine Pickworth, from Cancer Research UK, said: "It's encouraging to see this new drug is showing promise as a potential new treatment for ovarian cancer.
"The next steps will be for researchers to test the drug in larger clinical trials to confirm it works and is safe, and to work out which women with ovarian cancer this drug could help."
Prof Michel Coleman, of the London School of Hygiene & Tropical Medicine, urged caution.
He said: "Shrinkage of tumours is important, but as the authors point out, that is not the same as producing the hoped-for extension of survival for women with ovarian cancer.
"The excitement of the investigators is completely understandable, but one should be cautious about interpreting this result as a breakthrough for ovarian cancer patients until data on longer-term outcomes are available."

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Apple to scan iPhones for child sex abuse images

  Apple has announced details of a system to find child sexual abuse material (CSAM) on customers' devices. Before an image is stored on...