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One by one, the parents stood and described the unimaginable pain that Lucy Letby had inflicted on them. First, they shared the pure joy and outpouring of love they had felt at the birth of their children. Then they spelled out the sheer terror they felt when their babies started to collapse and die – seemingly without explanation.

But Letby, now one of only three women alive to be given a sentence of life in prison without parole, was not there to hear their heartbreaking testimonies, having refused to come to her sentencing at Manchester Crown Court on Monday; a final act of cowardice from the UK’s most prolific child serial killer.

Letby’s parents, who had supported her throughout the ten-month trial, were also absent from court room 7, but more than a dozen relatives of Letby’s victims sat in the packed public gallery. Eight of the jurors, who had sat through ten months of harrowing evidence, also returned, this time looking at an empty dock where the defendant had sat during the trial.

The court heard victim impact statements from the parents of a number of the children Letby killed. Some jurors became visibly upset as they listened. Journalists who had covered the trial week in week out also struggled to hold in their emotions.

Lucy Letby refused to appear in court for sentencing (PA Media)

Prosecuting lawyer Nick Johnson KC read out the statements from those who could not bring themselves to speak publicly. Two parents had recorded video testimonies and tried to keep themselves together as they described how their lives had been destroyed by Letby’s calculating crimes.

The parents spoke of how 33-year-old Letby had not only killed their babies but been intimately involved in caring for their children in death. With a trembling voice, the mother of Child E told the small court room that she had been forced to grieve her beloved child at the neonatal unit in front of Letby – who, unbeknown to her at the time, had just killed her child.

Agonisingly, her precious baby had also been buried in a gown that had been chosen by Letby and given to her by the unit.

The mother of Child O and P, who were also murdered by Letby, also addressed the court. She described how she has to live with the memory of Letby being the last person to hold her child and dress them before they died.

The mother of Child C had debated whether she should speak, scared that details about how her family had been hurt would satisfy the “sadistic” Letby. But her need to represent her child and showcase her love for them had compelled her to speak, she said.

That woman recalled the overwhelming wave of emotion she had felt when she first held her baby in her arms. The “immediate love” was something she would never forget. But neither would she be able to forget the shock and panic of the night her baby collapsed.

“The trauma of that night will live with all of us until the day we die”, she said.

The families of Lucy Letby’s victims branded the nurse ‘evil’ as they gave emotional victim impact statements during her sentencing hearing at Manchester Crown Court (PA Media)

When the time came for Mr Justice Goss to pass sentence, he started by addressing the injustice the families had suffered by not being able to speak to Letby directly.

His opening words cut through the courtroom: “The defendant, Lucy Letby, has refused to attend court for this sentencing hearing. Accordingly, I have to sentence her in her absence.”

He went through each death and attempted murder in harrowing detail, showing how Letby had injected the infants with air, force-fed others milk, and poisoned them with insulin. And he illustrated how the nurse had killed the babies in a number of different ways to mislead clinicians.

Speaking as if she were present, he continued: “You acted in a way that was completely contrary to the normal human instincts of nurturing and caring for babies and in gross breach of the trust that all citizens place in those who work in the medical and caring professions.

“The babies you harmed were born prematurely and some were at risk of not surviving, but in each case you deliberately harmed them intending to kill them.

“You have shown no remorse. There are no mitigating factors. You will spend the rest of your life in prison.”