ALFIE Evans was at the centre of a life support battle between his parents, health officials and the British justice system for several months - until he passed away in the early hours of April 28, 2018.
The tot's life support was switched off after his family lost the most recent of a series of legal appeals. Here's what you need to know about the heartbreaking case and his death.
Central News Alfie was born with a rare degenerative condition
Who was Alfie Evans?
Alfie Evans was living in a coma for well over a year after being struck down with a mystery illness.
The 23-month-old missed many developmental milestones in his first seven months.
He started making "jerking, seizure-like movements" and was taken to the doctors - but his parents were told he was "lazy and a late developer", the family claim.
Alfie caught a chest infection that caused seizures and was placed on life support at Alder Hey Children's Hospital in Liverpool in December 2016.
His life support was turned off on April 23, 2018, after a last-ditch bid by his parents was rejected.
He passed away at 2:30am on April 28, 2018, five days later.
Parents Tom Evans and Kate James broke the news to their Alfie's Army supporters on Facebook, saying: "Our baby boy grew his wings tonight at 2:30 am. We are heartbroken."
Central News Doctors believed it was inhumane to keep Alfie alive
What do we know about his illness?
Alfie, who was born on May 9, 2016, was in a "semi-vegetative state" and had a degenerative neurological condition which doctors had not definitively diagnosed.
Some experts believed he might have had a mitochondrial condition - the same as Charlie Gard.
After he was admitted to Alder Hey, his parents were told he wasn't going to make it - but he fought back to beat the infection and began breathing on his own.
But he caught another chest infection and had to go back on a ventilator when he began having more chronic seizures.
Alfie was described as being in a semi-vegetative state and doctors at Alder Hey said it was in his best interest to stop mechanical ventilation.
What is mitochondrial DNA depletion syndrome?
Mitochondrial DNA depletion syndrome (MDS) refers to a group of disorders that cause affected tissues to suffer from a significant drop in mitochondrial DNA.
The DNA is found in the mitochondria of cells - an organelle found in most cells in which respiration and energy production occur.
This means, as in Charlie's case, that sufferers do not get energy to their muscles, kidneys and brain.
MDS causes progressive muscle weakness and brain damage.
The condition is rare and Charlie is said to be one of only 16 people to have ever had the condition.
MDS is almost always fatal in babies and young children, although some sufferers have made it into their teenage years.
There is currently no cure but some treatments have shown a reduction in symptoms.
One of these is Nucleoside bypass therapy.
Parents Kate James and Tom Evans fought to keep their little boy Alfie Evans alive
Who are Alfie's parents?
Alfie Evans' parents are Tom Evans and Kate James, both in their 20s and from Liverpool.
The couple consistently placed pressure on the justice system in a bid to keep their son alive.
Tom Evans was particularly vocal in speaking out in public, slamming every one of the court rulings.
The couple appear to be religious, with Tom citing the 10 commandments in a court case, reminding the court "thou shalt not kill".
Writing after judges at the European Court of Rights rejected the case, Tom said he and his partner were "in bits, distraught, in pain", and the decision meant their son was "about to be murdered".
Tom and Kate suffered a series of blows in their legal battles to keep Alfie alive.
They had taken their battle to the Supreme Court after the Court of Appeal agreed with Alder Hey that Alfie "could not be saved" and that it would be "unkind" and "futile" to continue treatment, but their bid was dismissed.
How brave Alfie battled his illness 9 May 2016 - Alfie is born in Liverpool to parents Tom Evans and Kate James. 1 December 2016 - Alfie is taken to Alder Hey Children's Hospital after suffering seizures. He will spend the next 12 months there. 11 December 2017 - The hospital and family disagree over Alfie's treatment, with his parents saying that the hospital applied to the High Court to remove parental rights and withdraw ventilation. 19 December 2017 - The High Court case begins with Mr Justice Hayden saying he will make a decision on what is best for Alfie. 1 February 2018 - A hearing begins at the High Court in Liverpool in which lawyers acting for the hospital claim further treatment for Alfie is unkind and inhumane. 2 February 2018 - One of Alfie's doctors tells the judge there is "no hope" for the youngster, who is in a semi-vegetative state from a degenerative neurological condition doctors have not been able to definitively diagnose. 20 February 2018 - Mr Justice Hayden rules in favour of the hospital and accepts medical evidence that further treatment would be futile. 6 March 2018 - Three Court of Appeal judges uphold the decision of Mr Justice Hayden. 20 March 2018 - Supreme Court justices refuse the couple permission to mount another appeal. 28 March 2018 - The European Court of Human Rights also rejects a request from the family to intervene. 16 April 2018 - Alfie's parents argue he is being wrongly "detained" at Alder Hey and make a habeas corpus application. Judges at the Court of Appeal in London rule against them. 18 April 2018 - Mr Evans flies to Rome and meets with Pope Francis. 20 April 2018 - The Supreme Court rules against Alfie's parents for a second time. 23 April 2018 - The ECHR rejects a last-ditch appeal. Supporters storm the hospital. Alfie is granted Italian citizenship. His life support is turned off at 9.17pm. 24 April 2018 - Alfie is still breathing on his own and has had oxygen and water, his father tells supporters. 25 April 2018 - Alfie's parents lose their appeal to take the tot to Italy for further treatment. 26 April 2018- Supporters of Alfie hold a candlelit vigil for the child at the Vatican as his father calls for demonstrations outside the hospital to end 28 April 2018 - Alfie dies five days after doctors turn off his ventilator
They had already lost a challenge at the Court of Appeal and failed to have the decision overturned at the Supreme Court and European Court of Human Rights.
Following one appeal, Lord Justice Davis, ruled that Alfie's life support must be turned off and told lawyers that doctors had agreed that there was "no hope".
He said: "We cannot have a kind of legal Groundhog Day where you come back again and again and again on the same point."
Alfie's life support was eventually turned off at 9.17pm on the evening of Monday, April 23.
However, the following morning his dad said that the little boy was still battling on and breathing unassisted hours later.
On the morning of Wednesday April 25, Tom said the tot was "still fighting", although the Court of Appeal was told he was "struggling" later in the day.
In the evening of April 25, Alder Hey Hospital was on lockdown amid rumours of a planned raid by protesters supporting the ill toddler.
He was barred from going to Italy for treatment after another failed legal challenge as the Appeal Court in London rejected his family's plea to have Alfie airlifted from the Liverpool clinic.
Merseyside Police warned supporters of Alfie's family that their social media posts were being monitored over reports that Alder Hey doctors were being hit with abuse.
Tom Evans stated that he would like to build a relationship with Alder Hey, and that the global pressure had stopped his family from "liv[ing] our lives as we would like".
"We are very grateful and we appreciate all the support we have received from around the world, including from our Italian and Polish supporters, who have dedicated their time and support to our incredible fight.
"We would now ask you to return back to your everyday lives and allow myself, Kate and Alder Hey to form a relationship, build a bridge and walk across it."
LATEST ON ALFIE EVANS CRUEL RUMOUR Aflie Evans' family deny dad Tom 'barricaded himself in hospital with body' 'RIP Alfie' Everton pay heartfelt tribute to Alfie Evans after tot tragically passes away 'TIME TO ACT' Campaign launched for Alfie's Law giving parents more rights - we reveal all ALFIE HEARTBREAK When did Alfie Evans pass away and what's happening now? BY THE BOOK Alfie's Army have a Facebook page & supported stricken tot since the start
What did the Pope have to say?
The high-profile case even caught the attention of the Pope, who pledged his support to keep Alfie alive.
The Holy Father tweeted: “It is my sincere hope that everything necessary may be done in order to continue compassionately accompanying little Alfie Evans, and that the deep suffering of his parents may be heard.
"I am praying for Alfie, for his family and for all who are involved.”
On April 18, Alfie's dad Tom visited Pope Francis and begged him to "save our son".
The pontiff had used an address to pray for the toddler, saying the situation was "very painful and complex".
He added that those who are terminally ill should be cared for "with unanimous support" from family and medical experts.
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Image copyright Kate James
Alfie Evans, the 23-month-old toddler at the centre of a High Court legal battle, has died, nearly a week after his life support was withdrawn.
The boy from Merseyside, who had a degenerative brain condition, died at 02:30 BST, his father Tom Evans said.
On Facebook he wrote: "My gladiator lay down his shield and gained his wings... absolutely heartbroken."
The Pope, who took a personal interest in the case, tweeted: "I am deeply moved by the death of little Alfie."
He added: "Today I pray especially for his parents, as God the Father receives him in his tender embrace."
Hundreds of supporters of Alfie's parents, known as Alfie's Army, released balloons at a park in a tribute to the toddler.
His aunt Sarah Evans thanked the crowd, saying: "Our hearts are broken. We are absolutely shattered as a family."
Skip Twitter post by @Pontifex I am deeply moved by the death of little Alfie. Today I pray especially for his parents, as God the Father receives him in his tender embrace. — Pope Francis (@Pontifex) April 28, 2018 Report
Alfie's parents lost all legal challenges to a court ruling allowing the hospital to withdraw ventilation.
The boy had his life support withdrawn on Monday after being in a semi-vegetative state for more than a year.
The legal campaign, launched by Mr Evans and Alfie's mother Kate James, attracted widespread attention and saw them clash with doctors over the child's treatment.
The case drew international support including from Pope Francis, who asked that "their desire to seek new forms of treatment may be granted".
Media playback is unsupported on your device Media caption Hundreds of well-wishers gathered to release balloons in tribute
Earlier in April, Mr Evans pleaded with him to "save our son" during a meeting in Rome.
Image copyright Christopher Furlong Image caption A woman grieves outside the children's hospital
A statement from Alder Hey Children's Hospital in Liverpool, where Alfie was treated, said staff expressed their "heartfelt sympathy".
"All of us feel deeply for Alfie, Kate, Tom and his whole family and our thoughts are with them. This has been a devastating journey for them," it said.
It asked those wishing to leave tributes to Alfie to place them at the nearby Springfield Park.
Image copyright Facebook
The RC Archbishop of Liverpool, Malcolm McMahon, said: "All who have been touched by the story of this little boy's heroic struggle for life will feel this loss deeply.
"Now it is time for us to give Tom and Kate space to grieve their son's death and offer our prayers for him and consolation for all."
Everton FC tweeted: "Everybody at the Club is deeply saddened by the loss of the brave young Evertonian. Our thoughts and prayers are with his family."
The Bradley Lowery Foundation, named after the six-year-old boy who died after suffering from neuroblastoma, paid tribute to Alfie's parents, saying "they did everything they could for their little boy".
Image copyright ACTION4ALFIE Image caption Alfie Evans was in a "semi-vegetative state" in Alder Hey Children's Hospital
Alfie, who was born in May 2016, was first admitted to the hospital the following December after suffering seizures, and had been a patient ever since.
His parents, who live in Bootle, wanted to fly the toddler to an Italian hospital, but this was rejected by doctors who said continuing treatment was "not in Alfie's best interests".
Alder Hey Hospital said scans showed "catastrophic degradation of his brain tissue" and that further treatment was not only "futile" but also "unkind and inhumane".
The couple heavily criticised medical staff, with Mr Evans suggesting his son was a "prisoner" at the hospital and had been misdiagnosed.
Image copyright PA Image caption Tom Evans and Kate James contested the hospital's decision to take Alfie off life support
Hospital bosses were backed by the High Court, which ruled in their favour on 20 February, after accepting medical evidence that there was "no hope" for the youngster.
In a four-month legal battle, Alfie's parents unsuccessfully contested the ruling at the Court of Appeal, Supreme Court and European Court of Human Rights (ECHR).
Alfie was granted Italian citizenship on Monday, with the country's government saying it hoped the toddler could have an "immediate transfer to Italy".
However, two days later the Court of Appeal upheld a ruling preventing the toddler from travelling abroad after life support was withdrawn.
Media playback is unsupported on your device Media caption On Thursday, Alfie's father Tom Evans urged campaigners to "return to your lives"
Supporters of Alfie's parents protested outside the hospital, prompting its bosses to defend staff who they said had endured a "barrage" of abuse.
On Monday, a group of protesters tried to get into the hospital after the ECHR refused to intervene.
Merseyside Police is investigating claims patients and staff had been intimidated.
On Thursday, Mr Evans thanked supporters but asked them "to go home" so the parents could build a relationship with the hospital to provide the toddler "with the dignity and comfort he needs".
The parents of Alfie Evans have said they are “heartbroken” after their son died in the early hours of Saturday morning.
A statement posted on Facebook by Kate James and Thomas Evans said the 23-month-old – who was being treated at Alder Hey Children’s Hospital in Liverpool – died at 2.30am.
The youngster was at the centre of a legal battle over his treatment that touched hearts around the world.
The post on Facebook said: “Our baby boy grew his wings tonight at 2:30 am. We are heart broken. Thankyou everyone for all your support.”
Alfie had been breathing on his own with just supplementary oxygen after having life support withdrawn around 9pm on Monday as part of his move to end of life care.
The previous day a group of 200 supporters who held protests and vigils outside Alder Hey, had tried to storm the hospital after the European Court of Human Rights rejected an application for Alfie to be taken out of the country for treatment.
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Mr Evans, 21 and Ms James, 20, had fought to take their son to Italy in the hopes that doctors there could diagnose Alfie’s condition, or prolong his life, though the family’s legal team had made clear they were not expecting a cure.
Despite being granted Italian citizenship on the intervention of the Pope the family’s attempt to take Alfie out of the UK was again blocked by the UK Court of Appeal.
Mr Evans said their lives had been “turned upside down” by the “intense focus” his case had received.
“Our little family along with Alder Hey has become the centre of attention for many people around the world and it has meant we have not been able to live our lives as we would like,” he said.
The fierce public campaign in support of the family also led to doctors,nurses and other people working at Alder Hey being “at the centre of a social media storm”.
Staff condemned the “guerilla tactics” of the so-called Alfie’s Army supporters, which included abuse and threats online, and even suggestions that they would pull the fire alarm and force evacuation of the hospital.
Merseyside Police eventually issued a warning and said it would investigate comments being made about the hospital online.
After accepting that their options had been exhausted, Alfie’s parents sought to build bridges with medical staff and pledged to work alongside doctors to give him “the dignity and comfort” he needed.
He said: “We... thank Alder Hey staff at every level for their dignity and professionalism during what must be an incredibly difficult time for them too.
“Together we recognise the strains (that) recent events have put upon us all and we now wish for privacy for everyone concerned.”
As in the case of Charlie Gard, Alfie’s treatment was seized upon by right wing and pro-life Christian groups in the UK and US who funded legal appeals, though the Court of Appeal said there was a “darker side” to the offers of support.
It has led to false claims that in a system like the NHS the government can decide who lives and dies, however the decision to move to end of life care was made by the medical team and upheld by the courts.
In the medical evidence put before the court, which was not contested by the family, doctors said Alfie is unable to swallow, see, or hear and has “profound developmental delay”.
It adds: “He will never make any developmental progress [motor skills, vision, hearing, social, emotional],” and does not respond to pin prick tests or other uncomfortable stimulation.
Alfie’s condition was not formally diagnosed and this was part of the reason for the fight to keep him on life support, but the judgement was made in part on the basis of scans which showed profound damage to his brain with no prospect of recovery.
In its judgement the Court of Appeal said the parents had received “misleading” legal advice that the should be able to take Alfie out of Alder Hey’s care, and said the Italian medical team had not suggested they had alternative treatment or tests that could help.
It added that it was “wholly wrong” to suggest that the “the parents own views can trump the judicial determination” on Alfie’s best interests, as had been proposed by the parents’ barrister.
A statement released by Alder Hey Children’s hospital on Saturday morning, said: “We wish to express our heartfelt sympathy and condolences to Alfie’s family at this extremely distressing time.
“All of us feel deeply for Alfie, Kate, Tom and his whole family and our thoughts are with them”.
Adding that this had been a “devastating journey” and the family’s privacy should be respected.
Parents of boy were embroiled in a protracted legal battle over his treatment before his death
9 May 2016: Alfie is born in Liverpool to Tom Evans and Kate James, now aged 21 and 20.
December: Alfie is taken to Alder Hey Children’s hospital after suffering seizures.
The Guardian view on Alfie Evans: a true tragedy | Editorial Read more
11 December 2017: Hospital bosses say they are liaising directly with the family after disagreements over his treatment. Alfie’s parents say the hospital has applied to the high court to remove parental rights and withdraw ventilation.
19 December A high court judge, Mr Justice Hayden, begins overseeing the case at a public hearing in the family division of the high court in London. The hospital says continuing life-support treatment would not be in Alfie’s best interests, but his parents disagree and say they want permission to fly him to Italy for treatment.
1 February 2018: A hearing begins at the high court in Liverpool in which lawyers acting for the hospital claim further treatment for Alfie is unkind and inhumane.
2 February: One of Alfie’s doctors tells the judge there is no hope for the youngster, who is in a semi-vegetative state from a degenerative neurological condition doctors have not been able to definitively identify.
5 February: Tom Evans tells the court Alfie “looks me in the eye” and wants his help.
20 February: Hayden rules in favour of the hospital bosses, saying he accepts medical evidence which shows further treatment is futile.
1 March: Three court of appeal judges begin analysing the case after Alfie’s parents mount a challenge to the high court ruling. The family ask for the appeal hearing to be adjourned for a few weeks so they can discuss the ruling with lawyers, but the judges refuse.
6 March: Court of appeal judges uphold Hayden’s decision.
8 March: Alfie’s parents ask for the case to be considered by supreme court justices.
20 March: Supreme court justices decide the case is not worth arguing and refuse to give the couple permission to mount another appeal.
28 March: Judges at the European court of human rights reject a bid from Evans and James for them to examine issues relating to Alfie’s future, saying they find no appearance of any human rights violation.
11 April: Hayden endorses an end-of-life care plan for Alfie drawn up by specialists.
12 April: Protesters gather outside Alder Hey hospital as Alfie’s father insists he has the right to take him home.
16 April: Alfie’s parents argue he is being wrongly detained at Alder Hey and make a habeas corpus application. Judges at the court of appeal in London rule against them and again uphold Hayden’s decisions.
17 April: Alfie’s parents ask supreme court justices to consider their case for a second time.
18 April: Tom Evans flies to Rome and meets Pope Francis.
20 April: The supreme court rules against Alfie’s parents for a second time, refusing them permission to appeal against the decision. The parents make an application to the European court of human rights in Strasbourg to take Alfie to Rome for treatment.
23 April: The European court of human rights refuses the application. Alfie is granted Italian citizenship. The Italian ministry of foreign affairs says: “The Italian government hopes that in this way, being an Italian citizen will enable the immediate transfer of the child to Italy.” A high court judge dismisses new submissions made in private by the lawyers for Alfie’s parents via telephone. At around 9pm, life support is withdrawn by doctors at Alder Hey hospital, according to Tom Evans. He says in a Facebook post that his son has been breathing unaided since 9.17pm.
25 April: Alfie’s parents fail in an 11th-hour attempt to persuade judges to let them move the terminally-ill youngster to a hospital abroad.
26 April: Alfie’s parents pledge to work alongside doctors to give the boy “the dignity and comfort he needs”.
28 April: The 23-month-old dies at 2.30am, his parents say on Facebook. “Our baby boy grew his wings tonight at 2:30 am. We are heartbroken. Thank you everyone for all your support,” the post says.
