Chapter 4: Illness and death

¶3.111 Mr Litvinenko was taken ill during the night of 1 November 2006. After a few days he

was admitted to Barnet Hospital. He spent two weeks there before being transferred to University College Hospital (UCH) on 17 November. His condition gradually deteriorated and he died on 23 November.

¶3.112 The purpose of this chapter is to record the evidence that I heard, much of it

uncontentious, regarding the events, and the course of Mr Litvinenko's symptoms, between 1 November and his death some three weeks later.

¶Onset of symptoms 3.113 Marina Litvinenko's evidence was that Mr Litvinenko fell ill suddenly and unexpectedly

during the night of 1 November. I have referred above to the evidence that Mr Litvinenko was generally in very good health. Although he had been sick a fortnight or so earlier on the evening of 16 October (a subject to which I shall have to return in some detail below), it seems that he had recovered from that episode within a couple of days.95 Mrs Litvinenko recalled that Mr Litvinenko had been "absolutely normal" on 31 October,96 and was again "absolutely fine" on the evening of 1 November when he returned from meetings in central London.97 Because it was the anniversary of their arrival in the UK, and their first such anniversary since acquiring British citizenship, Mrs Litvinenko cooked a special meal, which she and Mr Litvinenko ate together. Mr Litvinenko ate with a healthy appetite and suggested that they did not have a late night because he had promised to take one of Mr Zakayev's grandsons to school the next day, as well as having more meetings in London.98

¶3.114 Marina Litvinenko's evidence was that Mr Litvinenko started vomiting in the early

hours of 2 November. He spent the rest of the night in the spare room, but carried on vomiting. Mrs Litvinenko recalled that when she went to check him the next morning he looked "very exhausted" and was vomiting "again and again".99

¶3.115 Mr Litvinenko's condition worsened during the day on 2 November. He could not

keep any food or drink down. Mrs Litvinenko recalled telephoning a doctor in the local Russian community, a man called Yuri Prikazchikov, who recommended that Mr Litvinenko take salt and mineral solutions. She went to the chemist to buy the suggested treatments, but Mr Litvinenko simply vomited them back up again.100

¶3.116 By the middle of the next night, i.e. the early hours of 3 November, Mrs Litvinenko

decided to call an ambulance. She recalled that the ambulance came and that the paramedics examined Mr Litvinenko, but that they said that he was probably suffering from a bug or flu, and advised him to stay at home.101 Statements from the two members of the ambulance crew, which broadly confirmed this account, were read to the Inquiry.102

¶The Litvinenko Inquiry

¶3.117 Mr Litvinenko was worse again on the following day,³³ Marina Litvinenko 3/23-24 HMG000358 (page 3) INQ022399 (pages 23-24) November. He started to

complain of pain, and to experience bloody diarrhoea.103 Mrs Litvinenko's evidence was that it was on this day that she prevailed upon the Russian doctor to whom she had previously spoken on the phone to come and visit.104 Mr Prikazchikov, who gave evidence to the Inquiry, thought that he had visited on the previous day, but in light of the chronology he is probably wrong about that. Mrs Litvinenko and Mr Prikazchikov were, though, agreed on what he said when he visited. He said that Mr Litvinenko was probably suffering from either food poisoning (no other form of poisoning was mentioned) or an infection, but that either way he ought to be taken straight to hospital.105

¶3.118 Accordingly, Mrs Litvinenko again rang for an ambulance. The ambulance arrived

just after 4.00pm on 3 November and, on this occasion, took Mr Litvinenko to Barnet Hospital, where he was immediately admitted.106

¶Treatment in Barnet Hospital 3.119 Dr Andres Virchis, a consultant haematologist at Barnet Hospital, gave evidence

about Mr Litvinenko's care and treatment for the fortnight that he was a patient at that hospital.107 I also admitted into evidence Mr Litvinenko's medical notes from Barnet Hospital.108

¶3.120 The evidence that I received from such sources as to Mr Litvinenko's symptoms whilst

in Barnet Hospital, about the care and treatment that he received, and in particular about the attempts made by the medical staff to diagnose the condition from which he was suffering, may be summarised as follows: a. Mr Litvinenko had been suffering from abdominal pain, profuse diarrhoea and vomiting for two days when he was taken to hospital.109 An initial diagnosis of gastro-enteritis with mild dehydration was made;110 and Mr Litvinenko underwent a wide range of tests over the following days to try to identify the cause of his symptoms. The results of the initial blood tests showed that although the platelet count was normal, both haemoglobin and the white blood cell count were high.111 The blood test results also revealed that Mr Litvinenko had abnormally high levels of creatine and urea, indicating that he was dehydrated from the vomiting and diarrhoea112 b. On 4 November Mr Litvinenko was started on a course of Ciprofloxacin, a relatively strong broad spectrum antibiotic.113 However, further samples of Mr Litvinenko's blood were analysed over the next few days; and doctors observed that the platelet count fell to an abnormal level and the red and white blood cell counts fell further. The continuing decline in blood cell count caused increasing levels of concern114

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c. On or around 9 November, Marina Litvinenko asked Mr Litvinenko's consultant, Dr Dean Creer whether Mr Litvinenko's infection could have been the result of poisoning. She explained that her husband was usually extremely fit and healthy, but, "he knew of dangerous people and a friend of theirs had been poisoned and killed by these people", hence her anxiety. Dr Creer told her that the symptoms were common and that intentional infection/poisoning was not likely115

d. Dr Virchis took over Mr Litvinenko's care on 13 November. He was aware of Mrs Litvinenko's previously expressed concerns about possible poisoning,116 and he observed that Mr Litvinenko's condition did not fit with the previous evolving diagnosis of gastro-enteritis or of Ciprofloxacin toxicity.117 Further attempts were made by medical staff to identify a cause for Mr Litvinenko's declining condition and various investigations were carried out involving toxicology colleagues at Guy's Hospital poisons unit118

e. When considering the signs and symptoms with which Mr Litvinenko was presenting, it struck Dr Virchis that his presentation was similar to that of a patient suffering from acute leukaemia who had been treated with intensive chemotherapy and total body irradiation prior to a bone marrow transplant.119 The clinical notes reveal that radiology was to be asked to, "check radioactive sources of poisoning." Testing with a Geiger counter on 15 November did not detect radioactive emissions120

f. On 16 November Dr Virchis spoke to Mr Ivan House at the poisons unit. Mr House stated that preliminary results showed that Mr Litvinenko's condition should be treated as "suspicious thallium poisoning"; and treatment with Prussian blue was started that evening121

g. Dr Virchis was concerned that tests showed that Mr Litvinenko's bone marrow had degenerated and contained no discernible normal blood forming elements. He considered a bone marrow transplant to be the only means of restoring meaningful bone marrow function,122 and discussed the possibility of such a transplant with staff at University College Hospital (UCH). Mr Litvinenko was transferred to UCH on 17 November123

¶The hair sample 3.121 An incident of some importance to this Inquiry that took place whilst Mr Litvinenko was

in Barnet Hospital was the collection of some hair from his head. He had begun to lose his hair a few days after his admission to hospital. Marina Litvinenko explained in evidence that he found it very uncomfortable when his hair started to fall out, and she asked a Russian friend, Valentina Michenina, to come to the hospital and shave his head.124 Mrs Michenina gave oral evidence and had a clear memory of this incident.

¶The Litvinenko Inquiry

Her recollection was that when she went to the hospital for this purpose, a doctor asked her to pull out some of Mr Litvinenko's hair for testing, and gave them a clear plastic bag to fill for this purpose. She remembered pulling out Mr Litvinenko's hair where she could and filling the bag, then shaving the rest of his head. She said she gave the bag to Mrs Litvinenko.125 Mrs Litvinenko did not recall being directed by staff to fill the bag, but she did remember filling the bag with hair and putting it on Mr Litvinenko's bedside table with his other possessions.

¶3.122 To complete this part of the story, I also heard evidence from a nurse at UCH named

Gemma Trout.126 Ms Trout stated that she found a plastic bag of hair in the room on her ward that Mr Litvinenko had occupied before being moved to intensive care. She assumed that it was his. Her description of the bag broadly matched that given by Marina Litvinenko and Mrs Michenina. Ms Trout's evidence tallies with that of Marina Litvinenko, who remembered the bag of hair being transferred to UCH, and seeing it on Mr Litvinenko's bedside table there.127 Ms Trout gave the bag to the police. Deoxyribonucleic acid (DNA) tests performed much later demonstrated to an extremely high degree of likelihood that the hair in the bag was Mr Litvinenko's.128

¶3.123 As we shall see, these hair samples were of some importance to the scientific investigations that were subsequently carried out.

¶Visitors 3.124 Marina Litvinenko stated in evidence that she had visited Mr Litvinenko every day that

he was in hospital, often taking Anatoly with her.129 Mr Zakayev, too, said that he had visited every day.130

¶3.125 Both Mr Goldfarb and Mr Berezovsky were out of the country when Mr Litvinenko

was taken ill. Mr Goldfarb stated that he had been in Paris since 9 November. He said that he returned to London on 13 November and first visited Mr Litvinenko on 15 November. He appears thereafter to have visited Mr Litvinenko on a more or less daily basis.131

¶3.126 Mr Berezovsky was in South Africa, having flown there (as we shall see) on the

evening of 1 November. The evidence that he gave in his police witness statement was that he returned to the UK on 16 or 17 November and first visited Mr Litvinenko at Barnet Hospital on the day after he arrived back.132 This account tallies with Marina Litvinenko's evidence. She remembered him visiting for the first time on 17 November.133 Mr Berezovsky told the police that he then visited Mr Litvinenko daily.134

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¶Transfer to UCH and treatment there 3.127 As noted above, Mr Litvinenko was transferred to UCH late at night on 17 November.

¶He was an inpatient there for a little less than a week before his death on 23 November.

¶3.128 I heard oral evidence about Mr Litvinenko's medical treatment at UCH from

Dr Amit Nathwani, a consultant haematologist at that hospital.135 As with Dr Virchis, I also admitted into evidence the relevant medical notes.136

¶3.129 In summary:

a. Following Mr Litvinenko's arrival at UCH, he seemed to be responding well to the treatment with Prussian blue and reported feeling much better since the treatment had started

b. Professor John Henry, an internationally renowned toxicologist with an interest in rare poisons, became involved in advising on Mr Litvinenko's treatment. He died in 2007, but statements that he had given to the police were read into the record

c. Professor Henry stated that he had received a telephone call from Mr Goldfarb on 17 November. They discussed Mr Litvinenko's case and Mr Goldfarb told Professor Henry that Mr Litvinenko had been poisoned by thallium.137 Professor Henry visited Mr Litvinenko at UCH on 18 November and examined him with the agreement of the haematology team. Professor Henry stated that he agreed with the diagnosis of thallium poisoning138 and Mr Litvinenko continued to be treated with Prussian blue

d. Despite the early improvement in Mr Litvinenko's symptoms, he began to vomit blood; and Dr Nathwani thought that this might be an adverse reaction to one of the antibiotics with which he had been treated.139 Medical staff were also concerned that Mr Litvinenko appeared to have an irregular heartbeat, his temperature was raised, he continued to vomit and he had abdominal pain.140 An electrocardiogram (ECG) confirmed an irregular heartbeat.141 Dr Nathwani felt that he and his colleagues were in "uncharted territory" with the suspected thallium poisoning. Dr Nathwani therefore wanted to monitor Mr Litvinenko closely and considered the possibility of transferring him to a high dependency or intensive care unit (ICU) where his heart rate could be monitored continuously142

e. On 19 November, a bed became available for Mr Litvinenko on the ICU. The police expressed concerns as to security with regard to a transfer to the ICU. But Dr Nathwani decided that Mr Litvinenko should be moved for his own well being; he was transferred to the ICU later that evening143

f. Dr Nathwani assessed Mr Litvinenko's condition again on 20 November. He was concerned about Mr Litvinenko's bone marrow failure and raised temperature

¶The Litvinenko Inquiry

and noted that his falling platelet count created a risk of bleeding. In order to maintain the platelet count, Mr Litvinenko was given a blood transfusion. Dr Nathwani noted that, although the level of thallium in Mr Litvinenko's blood had been abnormal before his transfer to UCH, it was not elevated to the level that would indicate that he had been poisoned. The clinical picture at that time was one of bone marrow failure together with mucosal gut damage and hair loss; and Dr Nathwani was surprised to note that, given such serious symptoms, Mr Litvinenko did not have any significant damage to his nerve endings and had relatively low thallium levels.144 Fundamentally, Dr Nathwani remained puzzled by Mr Litvinenko's clinical presentation, and was concerned that it did not fit squarely with a diagnosis of thallium poisoning145

g. Mr Litvinenko's renal function then began to deteriorate and his blood was artificially filtered to remove toxins. This further complication added to the puzzle but Dr Nathwani observed in evidence that it is not unusual for patients with a persistent infection and a high temperature that is unresponsive to antibiotics to present with a gradual deterioration of other organs; he added that this is quite common in patients with bone marrow failure. But he was more surprised to note that Mr Litvinenko's liver function was also decreasing146

h. Dr Nathwani described fishing for diagnoses and further samples were taken in order to look for chromosomal changes.147 His registrar, Dr Kim Ryland discussed Mr Litvinenko's condition with Dr Dargan at Guy's Hospital poisons unit. She noted her colleagues' concerns that, clinically, Mr Litvinenko was not behaving like a patient with thallium poisoning because of the absence of neurotoxicity and the profound pancytopaenia (the absence of all types of blood cells). A further urine sample was sent to Guy's and the registrar at Guy's advised continuing with 'Berlin blue' (which Dr Nathwani explained is the same as Prussian blue) for seven to ten days and until urinary levels returned to normal, and that other causes of Mr Litvinenko's clinical presentation should be considered as thallium poisoning did not appear to be the primary cause148 of his condition

i. Dr Nathwani discussed Mr Litvinenko's condition again with Dr Dargan at Guy's poison unit on 21 November. Dr Dargan confirmed that they did not think Mr Litvinenko had thallium poisoning. Dr Dargan advised that Dr Nathwani investigate whether radioisotopes could be a potential cause, and gave Dr Nathwani the contact details for the Atomic Weapons Establishment (AWE). The poison unit's note of this conversation records the unit's view that there are only a few agents that would cause isolated mucositis and bone marrow failure149

j. Mr Litvinenko's condition continued to deteriorate on 21 November and during that night, he suffered two cardiac arrests from which he was resuscitated.150 On 22 November, doctors stopped treating Mr Litvinenko with Prussian blue as they were by then certain that he was not suffering from thallium poisoning

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k. Dr Nathwani recalled that it was on 21 November that the idea that chemotherapeutic agents or radioisotopes could have been used to poison Mr Litvinenko was first suggested by the pharmacist at UCH and colleagues at the poisons unit151 l. On the same day, Professor Henry was interviewed by journalists outside UCH, after visiting Mr Litvinenko for a second time. During the televised interview, Professor Henry expressed the opinion that Mr Litvinenko had been poisoned with radioactive thallium.152 Mr Clive Timmons (a Detective Superintendent in 2006) recalled speaking to DS Mike Jolly, who had seen Professor Henry's televised interview, later on 21 November. DS Jolly suggested to Mr Timmons that it would be useful to try to establish if radioactivity was affecting Mr Litvinenko. Consequently, samples of Mr Litvinenko's blood and urine were sent to AWE for testing153 m. The blood and urine samples arrived at AWE in the early evening of 21 November. Tests were conducted overnight154 n. A meeting between police officers, the forensic science service, AWE and Dr Nicholas Gent from Porton Down had been arranged for the following day,²²²² Sixsmith The Litvinenko File (pages 78-79); Cowell The Terminal Spy (pages 103-104) INQ019146 (page 25 paragraph 77) Marina Litvinenko 4/110-111 Marina Wall 32/75 Mascall 22/127 A1 2/131-140 November. During the meeting, the results of the urine tests at AWE, which revealed that polonium was present in Mr Litvinenko's urine, were discussed. However, it was thought that this reading was an anomaly caused by the plastic bottle in which the sample had been stored155 o. Mr Timmons had requested that a 'living post mortem' be carried out on Mr Litvinenko in order to try to establish the cause of his condition. In the course of the meeting Dr Gent presented five causes that had been identified as possibly contributing to his condition.156 One possibility, an internal radiation source, appeared to fit with the spike of polonium that had been identified in the tests at AWE. But those present at the meeting were of the view that this was an unlikely cause. It was decided that further investigation was needed. At AWE's request, a further sample of one litre of Mr Litvinenko's urine was sent to AWE for further testing157 p. The further urine sample arrived at AWE in the early afternoon of 23 November. Further testing was conducted. The results, which confirmed polonium contamination, were communicated to the police between about 3.00pm and 5.00pm158 q. At 8.51pm on Thursday 23 November, Mr Litvinenko suffered a third cardiac arrest. Mr James Down, ICU consultant, was on duty at the time and attempted to resuscitate Mr Litvinenko. But it became clear to him that Mr Litvinenko was not going to regain spontaneous cardiac output. The attempts to resuscitate were terminated; at 9.21pm Mr Down pronounced life extinct. He confirmed that Mr Litvinenko died from multiple organ failure including progressive heart failure159

¶The Litvinenko Inquiry

¶Police interviews 3.130 The Metropolitan Police Service conducted lengthy interviews with Mr Litvinenko for

the first three days that he was at UCH. The interviews took place in four sessions. The first session was very early in the morning on 18 November – from midnight until 2.45am; this would have been only a few hours after Mr Litvinenko arrived at UCH. The second session took place at the end of the same day, from 7.24pm to 11.49pm. The third and fourth sessions took place in the late afternoon and evening of 19 and 20 November respectively.

¶3.131 The senior of the two interviewing officers, Detective Inspector (DI) Hyatt, gave oral evidence to the Inquiry.160 3.132 The interviews were transcribed and I adduced the entirety of the transcripts into

evidence. It is, to put it mildly, unusual when inquiring into a death to have available lengthy transcripts of interviews with the deceased conducted shortly before his death. I regard these transcripts as being of great value to this Inquiry.

¶Mr Litvinenko's own explanation for his illness 3.133 It would appear that Mr Litvinenko was alive to the possibility that he had been

deliberately poisoned from the first days of his illness. Mr Prikazchikov recalled that Marina Litvinenko asked him whether Mr Litvinenko might have been poisoned when he visited the house, probably on 3 November.161 Mr Zakayev recalled discussing with Mr Litvinenko the possibility that he had been poisoned on either 4 or 5 November.162

¶3.134 Who did Mr Litvinenko think might have poisoned him? At the first of his police

interviews, in the early hours of 18 November, Mr Litvinenko told DI Hyatt that one of three people must have been the poisoner.163 The three men that he named were Mario Scaramella, with whom he had eaten at itsu during the early afternoon of 1 November, and Andrey Lugovy and Dmitri Kovtun, whom he had met later that day in the Pine Bar at the Millennium Hotel. Mr Litvinenko told DI Hyatt something else. He said that, although he had spoken publicly about his meeting with Mr Scaramella on 1 November, he had deliberately not said anything in public about his meeting with Mr Lugovoy and Mr Kovtun.164 His explanation to DI Hyatt, put shortly, was that he hoped that Mr Lugovoy and Mr Kovtun might be sufficiently confident that they were not suspects to return to London, where they could be arrested. In his oral evidence to me Mr Zakayev stated that this was a strategy that he and Mr Litvinenko had devised together.165

¶3.135 Shortly before Mr Litvinenko left Barnet Hospital, probably on 17 November, he gave

an interview to the journalist David Leppard. Mr Leppard wrote an article on the basis of the interview which appeared in the Sunday Times on Sunday 19 November. I admitted both a transcript of the interview and a copy of the article into evidence.166 It is apparent from those documents that Mr Litvinenko implied to Mr Leppard that he thought he had been poisoned by Mr Scaramella; he did not mention Mr Lugovoy or Mr Kovtun at all. The strategy that Mr Litvinenko described to DI Hyatt in his subsequent interview would appear to explain what would otherwise be a puzzling omission.

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¶3.136 There is, however, a further related point. It was a recurring feature of the evidence

that I heard from a number of Mr Litvinenko's friends and associates that during the time that he was in hospital he told them that he believed that Mr Scaramella had poisoned him on 1 November, and that he either delayed in telling them, or did not tell them at all, about his meeting with Mr Lugovoy and Mr Kovtun on the same day. Evidence to this effect was given by Yuri Shvets,167 Vladimir Bukovsky168 and Akhmed Zakayev;169 and Boris Berezovsky's witness statement is to a similar effect.170

¶3.137 The reluctance on the part of Mr Litvinenko to tell his friends about his meeting with

Mr Lugovoy and Mr Kovtun on the day that he became ill cannot be explained by his strategy to try to lure the two men back into the jurisdiction, since these were private conversations with trusted friends. The answer seems to lie in what Mr Shvets described as Mr Litvinenko's "wounded professional pride". He said:

"He was agonised by the understanding that as a professional he failed. … He was always saying that I can identify my enemy a mile away,… that I am a professional. But this particular case when it comes to his own life he badly failed."¹⁷¹¹⁷¹ Shvets 24/92-93 Mascall 12/95-103

Mr Zakayev, in a similar vein, explained that Mr Litvinenko, as a former FSB officer, had advised him on his personal security and had warned him that; "they might send a person from my past to me, someone who I'd had good relations with… it [was] that person that the threat would come from". He said that Mr Litvinenko was "embarrassed" that, "exactly this scenario… was turned against him."¹⁷²¹⁷² Zakayev 26/156-157 Mascall 12/103-104

¶3.138 These insights are, in my view, convincing. They are also valuable, because they

suggest that Mr Litvinenko's accounts of his meetings with Mr Lugovoy and Mr Kovtun – in particular, perhaps, his description of their meeting on 1 November – must be approached with some caution. It may be that these accounts contain some infelicities, added by Mr Litvinenko in an attempt to salve his wounded pride.

¶3.139 If the contemporaneous documents give rise to some uncertainty as to whom

Mr Litvinenko believed had poisoned him, there is no ambiguity as to whom he thought bore ultimate responsibility. Mr Berezovsky recalled that when he visited him in hospital Mr Litvinenko "insisted that it was a direct order of Putin", although at that stage Mr Berezovsky disagreed with him.173 Several days later, towards the end of his interviews with DI Hyatt, Mr Litvinenko stated:

"I have no doubt whatsoever that this was done by the Russian Secret Services. Having knowledge of the system I know that the order about such a killing of a citizen of another country on its territory, especially if it [is] something to do with Great Britain could have been given by only one person."

When DI Hyatt asked who that person was, Mr Litvinenko replied, "That person is the President of the Russian Federation Vladimir Putin".174 A few days later, as we shall see, Mr Litvinenko was to make a similar accusation in his final statement, which was published and widely circulated after his death.

¶The Litvinenko Inquiry

¶The photo and the deathbed statement 3.140 On Tuesday 21 November 2006, a photographer visited UCH and took the photograph

of Mr Litvinenko lying in his bed that became the iconic image of this case.175 I heard some evidence about the circumstances in which the photograph was taken.

¶3.141 Mr Goldfarb said that the idea for the photograph was his. He said that there had been

a "crowd" of press outside UCH following the publication of Mr Leppard's article on Sunday 19 November, and he thought that a photograph would be a way of creating extra interest in the story. He said that Mr Litvinenko was "adamant" about, "letting the world know that he has been poisoned by the Kremlin", and that he approved the idea of the photograph.176 Marina Litvinenko stated that she was against the idea because at that time she still hoped that Mr Litvinenko would survive, but she confirmed that Mr Litvinenko agreed both to the photograph being taken and to it being published.177 Lord Bell, whose agency arranged for the photograph to be taken, gave evidence before me. He recalled that Mr Litvinenko had been "particularly keen that people should see what had happened to him", and that, to that end, he had pulled his hospital gown to one side when the photograph was taken so that all the medical equipment was visible.178

¶3.142 It was on the same day,²¹²¹ Marina Litvinenko 3/41-43 Knuckey 7/38-44; see also Mr Knuckey's report and timeline relating to this incident: INQ019304; INQ019301 Marina Litvinenko 3/125-129 Marina Wall 32/63 Marina Wall 32/66-67 INQ016403 (pages 29-32) November, that Mr Litvinenko signed what has become

known as his deathbed statement. On the day after Mr Litvinenko's death, the statement was read to the media by Mr Goldfarb at a press conference held outside UCH, and was thereafter published widely.

¶3.143 The statement was short, and was in the following terms:179

"I would like to thank many people. My doctors, nurses and hospital staff who are doing all they can for me; the British Police who are pursuing my case with rigour and professionalism and are watching over me and my family. I would like to thank the British Government for taking me under their care. I am honoured to be a British citizen.

I would like to thank the British public for their messages of support and for the interest they have shown in my plight.

I thank my wife, Marina, who has stood by me. My love for her and our son knows no bounds.

But as I lie here I can distinctly hear the beating of wings of the angel of death. I may be able to give him the slip but I have to say my legs do not run as fast as I would like. I think, therefore, that this may be the time to say one or two things to the person responsible for my present condition.

You may succeed in silencing me but that silence comes at a price. You have shown yourself to be as barbaric and ruthless as your most hostile critics have claimed.

¶You have shown yourself to have no respect for life, liberty or any civilised value.

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You have shown yourself to be unworthy of your office, to be unworthy of the trust of civilised men and women.

You may succeed in silencing one man but the howl of protest from around the world will reverberate, Mr Putin, in your ears for the rest of your life. May God forgive you for what you have done, not only to me but to beloved Russia and its people."

The statement was signed in manuscript by Mr Litvinenko, and dated 21 November 2006.

¶3.144 Doubts have been expressed as to the authenticity of this statement, or at least as

to the extent to which it represented Mr Litvinenko's views. I therefore took detailed evidence on this subject. The key witnesses, who all gave oral evidence, were George Menzies, who was Mr Litvinenko's solicitor,180 Mr Goldfarb,181 Marina Litvinenko182 and Lord Bell.183

¶3.145 My conclusions regarding the so called deathbed statement are as follows:

a. The witnesses were agreed that the idea of the statement did not originate from Mr Litvinenko. Mr Menzies recalled the idea being suggested to him by a press consultant (not Lord Bell); Mr Goldfarb thought that the idea had emerged, "between me and George Menzies and Sasha"

b. Mr Goldfarb emphasised that the idea had emerged "naturally" because Mr Litvinenko "was so adamant in trying to get across the message that the Kremlin and Putin poisoned him". This is certainly consistent with other evidence that I have heard about Mr Litvinenko's thinking at this time

c. Marina Litvinenko was opposed to the idea of the statement because, as with the photograph, she still believed that Mr Litvinenko would survive – she said that preparing the statement was like giving up

d. Mr Menzies drafted the statement. The draft was prepared in English; there was never a Russian version. Mr Menzies dictated the statement and had it typed by his secretary. He had not discussed the statement in terms with Mr Litvinenko at that point, but he had visited him in hospital and discussed the possible causes of his illness, and the content of the draft statement reflected Mr Menzies' understanding of Mr Litvinenko's state of mind

e. Mr Menzies and Mr Goldfarb initially took the statement to Lord Bell. He was against the idea of the statement because he felt it read like a deathbed statement, and he still hoped that Mr Litvinenko would recover

f. Mr Goldfarb and Mr Menzies took the statement to UCH on 21 November. They showed it to Marina Litvinenko, who approved it and agreed that it should be shown to Mr Litvinenko

g. All three then went into Mr Litvinenko's room. Mr Goldfarb read the statement to him in Russian. Mr Litvinenko then asked for a pen and signed the statement

¶The Litvinenko Inquiry

Mr Menzies, Mr Goldfarb and Marina Litvinenko all told me that they were satisfied that Mr Litvinenko agreed with the content of the statement. I would add in this regard that the statement is consistent with views expressed by Mr Litvinenko to others at around this time, notably in his police interviews

¶Alexander Litvinenko's death 3.146 Tuesday 21 November and Wednesday 22 November were the last days that

Mr Litvinenko was conscious. He had lost consciousness by Thursday 23 November and died that evening.

¶3.147 At some point during this period Mr Zakayev brought an imam to Mr Litvinenko's

bedside. The evidence of both Marina Litvinenko184 and Mr Zakayev185 was that Mr Litvinenko, who had been baptised into the Russian Orthodox church, had expressed a desire to convert to Islam after talking with Mr Zakayev about his faith whilst he was still in Barnet Hospital. Mr Zakayev spoke the shahada with Mr Litvinenko, and later arranged the visit of the imam to UCH, with Marina Litvinenko's consent. Mr Zakayev's evidence to me was that he believed Mr Litvinenko died as a Muslim.

¶3.148 Mr Litvinenko's father, Walter, travelled from Russia and arrived at the hospital on

¶21 November.

¶3.149 As Marina Litvinenko was leaving Mr Litvinenko's bedside on the evening of

22 November, he told her that he loved her.186 Those proved to be the last words that he spoke to her. He remained unconscious throughout the next day.

¶3.150 Mr Litvinenko suffered a fatal cardiac arrest at 8.51pm on 23 November. The evidence

of Mr Down, an intensive care consultant on duty at UCH that evening, was that cardiopulmonary resuscitation (CPR) was commenced but was terminated when it became clear that Mr Litvinenko would not regain spontaneous cardiac output. Mr Down pronounced life extinct at 9.21pm that evening. He confirmed that Mr Litvinenko died from multiple organ failure including progressive heart failure.187

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