The family of Alfie Evans has lost its legal challenge to fly the toddler to Italy, as doctors from Alder Hey hospital consider whether he can go home after his life support was removed.

Mr Justice Hayden turned down the family's appeal today as the 23-month-old, who suffers from a degenerative neurological condition, clings to life more than 24 hours after the doctors in Liverpool stopped providing 'ventilation support'.

Alfie's parents, Tom Evans and Kate James, want him moved to a hospital in Rome, with an air ambulance on standby during the court hearing to fly him there after the Italian government granted him citizenship in a bid to have him transferred.

Doctors in Liverpool, who believe it is in Alfie's best interests to have life support switched off, say he cannot survive and that the trip would be wrong and pointless.

At a special High Court hearing in Manchester this afternoon, Mr Justice Hayden refused to let him fly to Rome, saying the long-running case had reached its 'final chapter'.

But he said Alfie was 'a fighter, resolute, courageous and a warrior' and asked doctors to consider whether he could be allowed to go home.

One of the hospital doctors said the soonest they could move him home would be three to five days, but that 'hostility' to doctors would make that impossible and that there was 'genuine fear' among medics.

Mr Evans claimed today that he and Alfie's mother 'had to give him mouth to mouth resuscitation to keep him alive because his lips turned blue'.

Supporters shared this photo of mother Kate James cradling her son at Alder Hey Hospital in Liverpool, where doctors have withdrawn life support

Tom Evans, Alfie's father, pictured speaking to supporters outside the Liverpool hospital today

Mr Evans has lost his latest appeal to have his son Alfie transferred to hospital in Rome today

The family of terminally ill toddler Alfie Evans have released pictures of the little boy clinging to life in his mother's arms 10 hours after his life support was removed

Medics have given the boy some oxygen and water but Mr Evans said his son (pictured today) will need further urgent medical assistance if he is to survive the day

On Tuesday morning, Tom Evans said doctors were 'gobsmacked' that Alfie was breathing on his own more than 10 hours after life support was withdrawn

How do medics reach decisions in cases such as Alfie Evans? Why would the decision to withdraw treatment from a child be made? Professor Russell Viner, of the Royal College of Paediatrics and Child Health, said: 'Every action and decision is taken in the best interests of the child, and decisions on care, including the withdrawal of treatment, are always made with the involvement of parents. 'We can't comment on the specifics of the case, only the medical team treating Alfie, and the legal team, will know the exact details and they are bound by patient confidentiality. 'However, we feel it is important for the public to know that decisions to withhold or withdraw treatment from a child are not made lightly.' In what circumstances does it happen? According to the UK's framework, treatment is withdrawn if it is unable or unlikely to result in the child living much longer, where it may prolong life but will cause the child unacceptable pain and suffering, or if an older child with a life-limiting illness repeatedly makes it clear they do not want treatment and this decision is supported by parents and doctors. How often are decisions like this made? Prof Viner said decisions on withdrawing treatment from children are made 'frequently'. He said: 'In the vast majority of cases an equal decision is made to withdraw treatment and it is rare that there is disagreement. 'The cases where this is a significant difference in view are the ones that grab the media headlines.' Why is Alfie continuing to breathe after life support treatment has been removed? Professor Dominic Wilkinson, consulant neonatologist at the John Radcliffe Hospital and director of medical ethics at the Oxford Uehiro Centre for Practical Ethics at the University of Oxford, said: 'In the last few hours, news reports have indicated that life support has been withdrawn from Alfie, and that he is breathing by himself. 'That does not mean that doctors were wrong, and it does not mean that breathing support should be restarted. 'The reason for stopping the breathing machines is simply that his serious condition is not treatable, and will not improve.' He added: 'Given the nature of Alfie's condition, the doctors have wanted to provide him with palliative care, focused on his comfort, and focused on making his remaining time as good as possible.' Is it euthanasia? Prof Wilkinson said: 'Providing palliative care is not euthanasia. 'It is about providing 'intensive caring' rather than intensive medical care. 'It does not end the child's life. 'Rather, it supports the child, and the child's family, for as long or as short as they remain with us.' Advertisement

A doctor giving evidence, who cannot be identified for legal reasons, said: 'If I was being honest I think in Alfie's situation [a return home] would have to be staged. I do not feel confident that we can say right now we can just send him home.

'We have to be sure we can work with the family and we are not going job obstructed by the supporters who are threatening us and posting things on Facebook.'

Around eight police officers in riot gear are guarding the courtroom at the Manchester Civil Justice Centre, with police also stationed outside the hospital where protests continue.

Mr Justice Hayden said he had told Mr Evans, who was not in court this afternoon, that not everyone in the Army [Alfie's Army, a supporters' group], 'had his back'.

Alder Hey doctors and independent medical experts say there is no cure and no hope for Alfie, who has a degenerative neurological condition.

Alfie's parents' barrister, Paul Diamond, had asked the judge to lift a court order stopping him leaving Alder Hey so he can travel to the Vatican's Bambino Gesu Pediatric Hospital for care because he is still breathing without a ventilator.

Posting on Facebook, Mr Evans said: 'Coming up to 24 hours and he’s fighting with gorgeous his gorgeous features, pink lips, handsome grown up face, and odd cheeky smile now and again.'

At the start of the ongoing hearing, Mr Diamond said: 'It's really an application for common humanity and common sense.'

But the judge interjected and told the lawyer to 'confine himself to the law' and avoid 'emotive nonsense', later adding: 'I don't need to be reminded we have a human being. You do not have the moral high ground in this court. It is treacherous terrain.'

Discussing Alfie's care, the judge said: 'The options of palliative care are to be discussed with Alfie Evans' parents with the objective of promoting a removal from hospital if possible.

'All this is to be predicated on the premise that the plan is to promote the best options for end of life care.

'There is no change in the degenerative state of his brain. There is capacity for something of his brain stem to generate breathing.

'But there is no sense of touch or taste or hearing and the brain remains predominantly water.'

Christian Legal Centre, the pro-life organisation behind Alfie's legal team, said an air ambulance was 'on hand' if needed.

The Italian government has also offered him a private jet while the Pope, who met Mr Evans last week, said he hoped that the parents' 'desire to seek new forms of treatment may be granted'.

The Italian ambassador's chief of staff was also reportedly in court this evening, although the judge ruled last night that Alfie was still a British citizen and therefore under the jurisdiction of UK courts.

Alfie's mother Kate James has posted harrowing images of the two-year-old surviving in her arms in his hospital bed today and said: 'How amazing is he. How beautiful does he look. No matter what happens he has already proved these doctors wrong'.

Tom Evans, 21, said his son's ventilator was removed at 9pm last night but claims his doctors are 'gobsmacked' that Alfie is battling on.

In his most recent update on his son at 8am, Tom told supporters on Facebook: 'My son is still ALIVE AFTER OVER 10 horrendous scary heartbreaking hours. Pray for him.'

Mr Evans claims to hold a letter from the Bambino Gesu Children's Hospital in Rome saying they will admit Alfie and attempt to treat him.

The Liverpool hospital said tonight: 'This evening the High Court again ruled that it is in Alfie's best interests to continue with the end of life care plan developed by the clinical team who have cared for him throughout.

'Our top priority therefore remains in ensuring Alfie receives the care he deserves to ensure his comfort, dignity and privacy are maintained throughout. This includes working closely with Kate and Tom as they spend this precious time together with him.

'We would be grateful if respect and consideration is shown to all our staff, patients and families at the hospital at this difficult time.'

Tom Evans, father of Alfie Evans, speaks to media outside at Alder Hey Children's Hospital

Police remain on guard outside Alder Hey today as a crowds of supporters gathered outside

Alfie's parents Kate and Tom have been updating supporters via Facebook as their son fights on

Why is the NHS ignoring the wishes of Alfie's parents? Alder Hey Hospital has won court battle after court battle arguing that it would be unfair to continue Alfie Evans' life support. In Britain the rights of the patient override the wishes of the parents if doctors disagree with a mother and father. For example there are several cases where Jehovah's Witnesses are given a blood transfusion by doctors despite religious objections from parents - and Charlie Gard was allowed to die against his parents' wishes last year. Alfie's doctors insists the child's interests must come first, and that means life support should be withdrawn. Doctors who gave evidence during the various court battles said Alfie's brain was badly damaged and his undiagnosed neurological, degenerative disease had progressed. They said they did not believe there was any chance of recovery. Alfie's father Tom says his brain could recover if the destructive process slows down. But judges accepted expert evidence that his brain tissue cannot regenerate and once nerve cells are destroyed, because they are gone. Alder Hey, therefore, won the right to end his life. Advertisement

Medics have given the boy oxygen and water but Mr Evans said his son will need further urgent medical assistance and food if he is to survive the day.

Today the head of the Vatican's Bambino Gesu Pediatric Hospital, Mariella Enoc, said she spoke to the Italian ambassador in London who said their plane could leave with him in a 'matter of minutes'.

But the hospital has also admitted the journey could cause Alfie more damage and could lead to 'continuous seizures' en route.

Experts told the High Court in February that Alfie may be able to breathe on his own without a ventilator but this 'will not sustain life'.

Alfie's parents have been locked in a bitter legal battle with Alder Hey, who insist it is in the two-year-old's best interests to die because he is in a 'semi-vegetative state' and has a degenerative neurological condition doctors have been unable to diagnose.

But the Pope has supported Alfie's parents Tom Evans and Kate James in their wish for him to be treated at the Bambino Gesu Hospital in Rome and last night he was granted Italian citizenship yesterday in the hope he can still be sent abroad.

Yesterday a 200-strong crowd gathered outside Alder Hey and some even tried to force their way in through the doors but were repelled by police.

'For nine hours Alfie's been breathing for now,' Tom Evans told reporters outside Alder Hey hospital at around 7am today.

Mr Evans said it became obvious he was breathing 'within a few minutes' of life-support being withdrawn, although doctors re-intervened after he asked them to help.

He said: 'I sat down with the doctor, it was a lengthy talk for about 40 minutes and he ended up saying that I'm right, and I was right, I've always been right.'

Mr Evans continued: 'They say Alfie's suffering. Well look at him now. He's not even on a ventilator and he's not suffering.'

Asked what intervention doctors had made, he replied: 'They left him for six hours without food, water and oxygen.

'I felt blessed when they confirmed they were going to give him his water and his oxygen.

'He's now on oxygen. It's not changing his breathing but it's oxygenating his body.

'He is still working, he's doing as good as he can.

'But we do need him to be supported ... in the next hour it's going to be hard but we will need him to be supported in the next hour or two.

'Because he's been doing it for nine hours totally unexpected, the doctors are gobsmacked and I do believe he will need some form of life support in the next couple of hours and I think he ought to be respected and given that.'

Protesters outside Alder Hey Hospital in Liverpool where Alfie is being treated

A large number of police are outside the hospital to prevent demonstrators trying to get in

Some supporters have held an overnight vigil for Alfie after it was announced his life support had been withdrawn

Alder Hey has urged parents only to bring children to A&E if there is an emergency and also asked Alfie's supporters to stop calling its switchboard

Q&A: Can Alfie be saved? Can doctors end Alfie's life against his parents' wishes? Alder Hey Hospital took Alfie's case to the High Court and a judge agreed to allow them to end his treatment because it was not in his best interests. The Court of Appeal, the Supreme Court and the European Court of Human Rights all rejected appeals by his parents, who believe they should have the final say on their son's treatment. Can the doctors change their mind and not turn off his life support? Yes. Alder Hey could go back to the High Court to stop the order they fought for this year - but it is highly unlikely. The process of gaining a Consent Order could be done on an urgent basis and completed in less than two hours. Experts have told MailOnline this is the only way he could travel to Rome for treatment. Can the hospital stop his parents taking him out of the country without permission? Yes. If doctors believe that any parent will cause suffering to their child, police can be called in to arrest them using Powers of Protection legislation. In the case of young cancer sufferer Ashya King his parents faced a European Arrest Warrant after absconding with their son who was in hospital. Alfie has been on a ventilator so would require a team of medical staff to move him and his equipment. If parents still refuse to accept treatment should be withdrawn, can the hospital end it anyway? Yes. Police could be called in to facilitate treatment being ended if parents were violently preventing it - although it is highly unlikely this would happen. Doctors are more likely to try to 'persuade' parents to let it happen. If the parties remain at loggerheads for a long period the hospital could go back to court for an injunction and ask a judge to set a deadline for treatment to be withdrawn. Advertisement

The removal of life support comes after the family lost a 'last-ditch' appeal last night to delay the withdrawal of treatment and mount a further legal challenge.

Alder Hey has said it is not going to give updates on Alfie's condition.

A spokesman said: 'We wish to reassure patients and families attending Alder Hey hospital today that we are operating as usual and that, although you will see a police presence, the hospital is calm. Please attend your appointments as normal.

'Our Emergency Department is still open, however only attend if you have an accident or emergency that requires urgent care. If it is not an emergency please attend your local GP or visit your walk-in centre.

'Please be aware, out of respect for the privacy of Alfie and his family we will not be issuing any updates about his condition.'

Italy granted citizenship to the 23-month-old in a bid to have him transferred to a hospital in Rome, as the Pope intervened again in the case to say he hoped the boy's parents would be able to seek new treatment.

The Italian Foreign Ministry said it hoped the decision would allow for the toddler's 'immediate transfer' to a hospital where Alfie's father Tom and mother Kate James, 20, say doctors are willing to treat him.

But a High Court judge dismissed a last-ditch appeal on Monday night by Alfie's parents to delay and mount a further challenge, as Mr Justice Hayden gave doctors the go-ahead to stop treatment and said Alfie still came under the jurisdiction of British courts.

Around midday yesterday protesters briefly blocked the dual carriageway outside Alder Hey Hospital in Liverpool, and an ambulance became trapped as traffic was backed up.

Campaigners, linking arms and chanting 'Save Alfie Evans' allowed the ambulance to pass before abandoning the protest in the road. Then an angry mob ran towards the main doors of the hospital before police scrambled to block them off.

The mother of a young child being treated at Alder Hey said Mr Evans 'needs to tell them to get away from the doors'. She added: 'It's not fair on all the kids. My daughter was really frightened.' Lawyers for Alfie's parents have launched a private prosecution which is understood to be directed at staff treating him at Alder Hey.

Alfie Evans' father Tom speaks to media and a large crowd outside Alder Hey hospital on Tuesday morning after announcing his son was breathing unassisted

The removal of life support comes after the family lost a 'last-ditch' appeal last night to delay the withdrawal of treatment and mount a further legal challenge

Police attempt to keep protesters, one pushing a pram, out of the hospital's revolving door

The Pope, who previously met Alfie's father, intervened again in the case to say he hoped the boy's parents would be able to seek new treatment

Alfie Evans: Timeline of case brought by parents against NHS hospital His parents Tom Evans and Kate James have battled through the courts to save their son May 2016: Alfie Evans is born apparently perfectly healthy, but misses numerous developmental milestones in his first seven months December 2016: Alfie catches a chest infection causing seizures, and is taken to Alder Hey Children's Hospital in Liverpool where he is put on life support. He has been there ever since July 2017: Father Tom Evans says he is seeking US treatment for his son and hopes Charlie Gard's supporters will help after he claimed doctors want to turn off Alfie's life support. February 1 2018: The case goes to the High Court in Liverpool, where the hospital reveal the parents smuggled a German doctor into hospital in a bid to stop the life support from being switched off February 20: Mr Justice Hayden rules that doctors can stop providing treatment to Alfie. March 1: Court of Appeal judges refuse to give the parents more time to think before deciding on their next move. March 6: Three Court of Appeal judges back High Court judge's ruling that that doctors can stop treating Alfie. March 20: A panel of three justices, headed by Supreme Court president Lady Hale, decide that the case is not worth arguing and refuse to give the couple 'permission' to mount a further appeal. April 11: A High Court judge endorses an end-of-life care plan for the 23-month-old boy. April 18: Alfie's father kisses the hand of the Pope and begs him to 'save our son'. April 20: Supreme Court rejects latest legal bid for the youngster to travel. April 23: European Court of Human Rights refuses to intervene. The Italian Foreign Ministry grants Alfie citizenship amid protests outside the Liverpool hospital. April 23: Alder Hey removes life support for Alfie Advertisement

Mr Evans said withdrawal of life support would be a 'straight up execution'. He earlier posted on Facebook to say he was waiting for Italian authorities to call UK Foreign Secretary Boris Johnson.

Judges have heard that Alfie, born on May 9 2016, is in a 'semi-vegetative state' and has a degenerative neurological condition doctors had not definitively diagnosed.

On Monday night, Paul Diamond, who represents the couple, told the judge that Alfie had been granted Italian citizenship on Monday, saying there was now an 'international relations element' to the case.

But Mr Justice Hayden dismissed Mr Diamond's application, saying it amounted to a 'last-ditch appeal' and said Alfie was a British citizen and 'habitually resident in the UK', meaning the High Court had jurisdiction.

Doctors in Liverpool have said the flight to Italy would be too difficult for him and UK courts, including the Supreme Court, have upheld their decision. The European Court of Human Rights refused to intervene in the case.

Speaking outside the hospital on Monday night, Mr Evans: 'I'm stood here now and Alfie is still here. Why? Because I'm still fighting for him, I'm still fighting and so is Alfie. I have been in touch with the Ambassador of Italy. My son belongs to Italy. I love Alfie and I love Kate, I will not give up.'

Around 100 people remained outside Alder Hey Children's Hospital awaiting news on Alfie Evans while a line of police officers guard the main entrance, with more police stationed at other entrances.

Pope Francis said on Twitter: 'Moved by the prayers and immense solidarity shown little Alfie Evans, I renew my appeal that the suffering of his parents may be heard and that their desire to seek new forms of treatment may be granted.'

A source close to the Evans family said a UK judge would hold an urgent telephone conference with Italian legal representatives to discuss Alfie's plight.

Alfie's father met the Pope last week to ask for asylum, kissing the pontiff's hand and begging him to 'save our son'.

The head of the Bambino Gesu Pediatric Hospital, which is administered by the Vatican, also travelled to Liverpool in a bid to have the boy transferred, saying Pope Francis asked her to do everything 'possible and impossible' to save him.

The hospital previously offered to help in the case of Charlie Gard, who died from a rare form of mitochondrial disease that causes progressive muscle weakness, including in his organs.

Alfie Evans is in a 'semi-vegetative state' and has a degenerative neurological condition

Tom Evans pictured with the Pope, who has thrown renewed support behind the family

Mr Evans' sister Sarah also emerged briefly from the hospital to tell supporters that Alfie's 'heartbroken' father was still inside the hospital.

Pope Francis' hospital offers private jet to get Alfie Evans to Rome Bambino Gesu, a children's hospital owned by the Vatican and known as the Pope's Hospital (pictured), has secured a plane ready to jet Alfie Evans to Rome today. The hospital has contacted Aldey Hey Children's Hospital about Alfie's transfer and has also sent doctors to his bedside. Bambino Gesù is the largest paediatric hospital and research centre in Europe. The hospital has a staff of almost 2,600 including physicians, researchers, nurses, clinical technicians and office staff. Its slogan is: 'You think about your child, we'll think about everything else'. It was also heavily involved in the tragic case of Charlie Gard and had also offered to care for him before he died last year. Bambino Gesu was criticised last year after the publication of a damning investigation in the Italian Press, which accused Bambino Gesu of putting profits before the welfare of children. The scandal occurred before boss Mariella Enoc joined the hospital. Advertisement

Their case went before the European Court of Human Rights (ECHR) after it was rejected by the UK's Supreme Court, but judges in Strasbourg also refused to intervene, saying the application was 'inadmissible'.

Following the decision, around 200 people gathered outside Liverpool's Alder Hey hospital, as supporters blocked the road outside the hospital, linking arms and chanting, 'Save Alfie Evans!'

Dozens had ran towards the main doors before police officers stationed inside and out strung across the entrance blocking the way, and after after a short stand off the crowd retreated to gather around 100 yards away on the road outside.

One woman described the crowd as 'terrifying', saying: 'Everyone just ran and were going for the doors, pushing police out of the way - but they weren't going to get in past the police.

'I understand people want to support Alfie and I've got a lot of respect for people who want to support him but I've got respect for the hospital as well because they've saved my little girl's life.'

Another woman whose child is being treated at the hospital after being in a car accident and whose son had a separate appointment at the hospital said: 'We support Tom and Kate but we don't support them storming.

'We were walking out and I had my baby in a wheelchair. I was getting tossed and turned by coppers trying to get out and my baby was terrified,' she said.

Some Twitter users compared the case negatively to the national euphoria following the birth of the royal baby on the same day.

One said: 'A royal birth means nothing to me I'd rather focus my attention to things closer to home and show my support for Alfie Evans. All the best little man.

Another said: 'My thoughts are with Alfie Evans today, not the royal baby.'

Some of the protesters attempted to get into the hospital as police guarded the entrance

Some of the group surge towards are door after protesters tried to block a road to the hospital

A large crowd of around 200 demonstrators gathered outside the hospital on Monday

It comes after a British judge said flying Alfie to a foreign hospital would be wrong and pointless, in a decision since backed by Britain's Appeal Court and the Supreme Court.

An ECHR spokesman said on Monday: 'The European Court of Human Rights has today rejected the application submitted by the family of Alfie Evans as inadmissible.'

The couple have argued that Alfie is being wrongly 'detained' at Alder Hey and have made a habeas corpus application.

A writ of habeas corpus - Latin for 'you may have the body' - is a legal manoeuvre which requires a court to examine the legality of a detention.

It is a piece of common law which probably dates back to Anglo-Saxon times.

A spokesman for Alder Hey said: 'Alder Hey Children's Hospital remains open as usual for all visitors and appointments, however visitors may notice an increase in visible police presence in and around the hospital site - this is part of our ongoing security arrangements.'

The case has echoes of that of Charlie Gard, who was born in August 2016 with a rare form of mitochondrial disease that causes progressive muscle weakness, including in his organs.

The British boy died on July 29, one week short of his first birthday, after doctors withdrew life support treatment.

Gard's parents fought a five-month legal battle for him to be taken to the United States for experimental treatment.

They lost a series of appeals in British courts and the ECHR.

Around 200 people gathered outside the hospital after Mr Evans said his son would die soon

Chief Inspector Chris Gibson of Merseyside Police said: 'We continue to provide a policing presence at Alder Hey and recognise the sensitivities involved in this very difficult and sad situation.

'We would like to remind the public that this is a hospital for sick children and it should not be forgotten that many families are going through extremely challenging and emotional times.

'We would ask protesters to respect families and staff, including the poorly children in the wards and to ensure that access to the hospital is not restricted at any time, so that services including the blood and ambulance service can run as efficiently as possible.'