Medics, housing bosses and loved ones of Awaab Ishak are among those to have given evidence at an inquest into the toddler's death. Awaab died just eight days on from his second birthday on December 21, 2020.
He breathed in severe levels of mould at his home on the Freehold estate in Rochdale, which is owned and managed by Rochdale Boroughwide Housing (RBH). It is the same estate where the Manchester Evening News spoke to families whose children had also suffered breathing difficulties, as they were engulfed in their own battles with damp and mould.
Awaab's family made several complaints and requests to move home before his death, his inquest has heard. After struggling with his breathing, Awaab was admitted to hospital on December 19, 2020, and discharged the following morning.
READ MORE: Heartbreaking letter reveals health visitor's plea over Awaab Ishak's mouldy home
But he returned the next day, when he was pronounced dead after suffering a cardiac arrest brought on by respiratory failure. Coroner Joanne Kearsley has heard evidence given by key witnesses under oath at Rochdale Coroners Court since Friday, November 4.
She will give a conclusion based on the evidence and make comments about what she has heard this week. Ahead of the inquest's final day in court, here is a round-up of all the key evidence that has been heard.
'A happy, smiley baby'
Awaab Ishak was born in Oldham on December 13, 2018. His father, Faisal Abdullah, came to the UK as an asylum seeker from Sudan in July 2015 and was joined by his wife, Aisha Amin, in February 2018.
At 31 weeks, Awaab was born prematurely but 'in good condition', according to consultant neonatologist Dr Natasha Maddock. The court heard Awaab could breathe on his own by day three and was allowed to go home after he began to feed normally.
Lyndsey Ryan, Awaab's first health visitor, described him as a 'happy, smiley baby' living in a 'warm and welcoming' home. Along with mum Ms Amin, he was 'part of the furniture' at Deeplish Children's Centre, attending numerous sessions there according to early years worker Lauren Hughes - who had 'no concerns' about the family.
Caroline Ridley, who replaced Ms Ryan as the youngster's health visitor in late 2019, described Awaab's development as 'good' following his premature birth. Awaab's GP practice, Ashworth Street Surgery, was contacted on several occasions in the toddler's short life about cold-life symptoms, including for viral respiratory infections in 2020.
Dr Kevin Cody, a GP at the practice, said Awaab was 'seen more than most children' for those symptoms - but confirmed he was never diagnosed with autism or another chronic respiratory condition. However, Ms Hughes and Ms Ridley had not been concerned about the coughs and colds, which were described as 'not unusual for young babies' by the health visitor.
'They said it was disgusting'
Having lived in a number of properties after first arriving in the UK, Mr Abdullah settled at a flat in the Ilminster block on Freehold in August 2016. He began to notice 'black dots' of mould in his kitchen from October 2017, and it was the first time Mr Abdullah had come across the issue.
The court heard he took a photo of the mould and showed it to staff at RBH's housing office, who told him he 'would have to paint over it', but did not specify that he should use specialist anti-mould paint. Having followed the advice, Mr Abdullah said the mould returned in October 2018 and 'covered a bigger area' in his kitchen and bathroom than in the year before.
He painted the area again before his son was born, the court heard. But by May 2019, Mr Abdullah began making more frequent complaints about the issue, and applied for a new property for his family.
On a visit to the flat in July 2020, Ms Ridley was shown mould in the kitchen and bathroom, which the court heard described as 'obvious'. She wrote a letter of support to RBH for the family's application to move home.
Ms Amin, who by late 2020 was pregnant with her second child, described how the damp and mould at her home made her feel. She told the inquest: "When anyone came to the flat they said it was disgusting and I felt sad about it. I would rather visit my friends than have people visit the flat."
Stalemate over the mould
Mr Abdullah told the court he found a post on Facebook about damp and mould with a contact number, and he was put forward to a solicitor - in a process RBH's barrister would describe in court as 'claims farming'. Anthony Hodari solicitors picked up the case, and a disrepair claim reached the housing association on June 12, 2020.
The court heard that policy at RBH, in line with other social housing providers, was not to conduct remedial work on properties subject to legal claims until solicitors had approved it. On July 9, 2020, Awaab's health visitor Caroline Ridley wrote to RBH supporting the family's application to move home, after seeing the mould at the property for herself.
The letter referred to Awaab, but his inquest heard how it was not attached to an IT system called CRM which is supposed to be used by all RBH staff, and some workers told the court they believed Mr Abdullah was living alone at the flat. They included Mark Wrigley, who inspected the flat on July 14 to prepare a report of work that was required.
He told the court he 'would have carried out the work without waiting for a reply' from Anthony Hodari solicitors if he knew Awaab lived in the property. A statement from Stephen Lund, director at Anthony Hodari, said the family's case had been dropped in September 2020 - but neither the firm nor RBH contacted the other party with updates, and the housing association believed the case was outstanding for the rest of the year.
Meanwhile, Ms Amin had told midwives dealing with her second pregnancy about the damp and mould at her home, and they submitted three 'special circumstances' forms they believed would be picked up by Rochdale safeguarding, the court heard. But the initial form was not received by children's social care, safeguarding midwife Rebecca Oatway told the inquest, while the later forms were only sent to the family's health visitor.
However, the case was picked up by Rochdale's Early Help service. Lauren Hughes contacted RBH about the issue in November 2020 and was told the case would be passed over to the relevant team, the court heard, but after chasing the issue up the following month she received no reply. Three RBH workers who visited the property told the inquest they believed moisture issues in the bathroom were being made worse by 'ritual bathing', with Andrew Foster saying he 'assumed' the situation after seeing a 'bucket'.
But Mr Abdullah insisted this was not in his family's culture and they instead took showers. Inspections before and after Awaab's death highlighted ventilation issues in the property, with Rochdale Council surveyor Daniel McVey describing the flat as 'unfit for human habitation' without repairs.
'I saw my son in bed surrounded by doctors'
The court heard that in 2020, Awaab's parents feared the damp and mould was affecting his health, while he was struggling to breathe through his nose and suffered with a 'continuous cough' in his final weeks. Mr Abdullah told his GP on December 16, 2020, that Awaab had dealt with a sore throat for three weeks and three days later the toddler was taken to Rochdale Urgent Care Centre with breathing difficulties.
He was transferred to Royal Oldham Hospital, treated for croup and discharged on the morning of December 20. The court heard Dr Phillipa Marshall, who saw Awaab at OIdham, told Ms Amin that if his condition worsened he should go to 'hospital' using Google Translate - but she did not specify Oldham.
On December 21, Mr Abdullah took Awaab to Rochdale Urgent Care Centre, where he was again transferred to Royal Oldham Hospital. Awaab suffered a cardiac arrest as he was transferred to Oldham and Northern Care Alliance, which runs both sites, admits the toddler 'would not have died at the time he did' if he had gone to Oldham sooner and received specialist care there.
Ms Amin arrived at the hospital after her own antenatal appointment, telling the inquest: "When I got to hospital I saw my son in bed surrounded by doctors. About 30 minutes after arriving, Awaab died." Mycology expert Prof Malcolm Richardson found evidence of a number of species of fungal allergens inside Awaab's home following his death.
Home Office pathologist Dr Philip Lumb, who carried out Awaab's post-mortem, discovered 'severe swelling' of the toddler's airway and swelling to the back of his throat - while a cell showed the presence of fungus in Awaab's blood. Giving the medical cause of death as acute airway oedema with severe granulomatous tracheobronchitis, due to environmental mould exposure, he said: "Exposure to fungus appeared to be the most plausible explanation - or the only explanation."
The court heard that Greater Manchester Police gathered evidence earlier this year from a number of a other properties on Freehold which had been affected by damp and mould. However, Detective Chief Inspector Mark McDonell told the court that the evidence gathered would not meet the threshold for criminal charges being made against RBH on the grounds of gross negligence manslaughter or corporate manslaughter.
'The mould took over'
Witnesses from RBH, Rochdale Council and the NHS all told the inquest that issues of damp and mould are becoming increasingly common in the borough. When Mr Wrigley took on his role as the housing association's disrepair manager in 2019, there were 600 outstanding mould treatments for the painting team to carry out.
He admitted: "Eventually, the mould took over the painting." Ms Hughes said it was common for early years workers like her to get involved in housing issues in Rochdale, adding: "We get a lot of families coming to the children's centre - pre-Covid, during Covid and even now - requesting support for housing, asking for us to come and see the conditions that they are living in."
Dr Cody also said Ashworth Street Surgery was seeing 'more patients' reporting issues with their property, and there was a greater awareness of damp and mould affecting health following Awaab's death, while Dr Sri Nagesh Panasa told the inquest his team at Northern Care Alliance has written letters about damp and mould issues raised by patients. Damp and mould is not only an issue affecting Rochdale either.
Prof Richardson told the inquest that '50% of social housing has a problem with mould', as he called the situation in England 'dire'. He added: "Most of these problems are due to a lack of attention to defects. Landlords have a duty of care to provide a habitable property - that's not always the case."
England's housing ombudsman Richard Blakeway is calling on social landlords to take a more proactive approach to tackling damp and mould - and told the inquest it could be 'too simplistic' to blame residents for the issue. He said: "There may be factors like fuel poverty, age and design of homes, which may make the risk of damp and mould greater... those are known risks and therefore it's important for them to think about their approach to make sure they address those known challenges."
Nadhia Khan, director of customer and community at RBH, admitted that properties on the Freehold estate can be affected by insufficient ventilation. She told the inquest work had taken place to improve ventilation at many of the flats, including the property that Awaab Ishak had lived in, while RBH is now dealing with mould and damp in a more 'proactive' way. Proceeding.
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