The experiences of victims of the contaminated blood scandal are “harrowing”, “moving” and “chilling”, the public inquiry’s chair has said.
Former judge Sir Brian Lanstaff, opening his two-year probe, praised the bravery of those giving evidence.
Victims told the hearing their lives had been ruined by what had happened.
The inquiry is looking at how thousands of people were infected with hepatitis C and HIV from contaminated blood they were given in the 1970s and 1980s.
It has been called the worst treatment disaster in the history of the NHS.
About 5,000 people with haemophilia, a genetic condition that prevents blood from clotting properly, were infected with hepatitis C, HIV and other infections when they were given blood products to help their blood clot. More than 2,000 are already thought to have died.
Thousands more may have been exposed through blood transfusions after an operation or childbirth.
Speaking at the opening of the inquiry, Sir Brian said: “I have already read a large number [of the witness statements] more than once, some a number of times.
“Some are harrowing, some incredibly moving, some chillingly factual. There are more to come.”
After the inquiry hears from people in London, there will be other hearings in Belfast, Leeds, Edinburgh and Cardiff in the coming months.
Victims and relatives want to know why warnings about the safety of the blood products may have been ignored, why plans to make the UK self-sufficient in blood products were scrapped, and why many documents and patient records appear to have been lost or destroyed.
What is the scandal about?
About 5,000 people with haemophilia and other bleeding disorders are believed to have been infected with HIV and hepatitis viruses over a period of more than 20 years.
This was because they were injected with blood products used to help their blood clot.
It was a treatment introduced in the early 1970s. Before then, patients faced lengthy stays in hospital to have transfusions, even for minor injuries.
Britain was struggling to keep up with demand for the treatment – known as clotting agent Factor VIII – and so supplies were imported from the US.
But much of the human blood plasma used to make the product came from donors such as prison inmates, who sold their blood.
The blood products were made by pooling plasma from up to 40,000 donors and concentrating it.
People who had blood transfusions after an operation or childbirth were also exposed to the contaminated blood – as many as 30,000 people may have been infected.
By the mid-1980s, the products started to be heat-treated to kill the viruses.
But questions remain about how much was known before this and why some contaminated products remained in circulation.
Screening of blood products began in 1991. And by the late 1990s, synthetic treatments for haemophilia became available, removing the infection risk.
The victims’ stories
Hundreds of victims and their families are expected to give evidence during the inquiry.
One of the first people to give evidence in person was Derek Martindale, who has haemophilia.
He said he was 23 when he was diagnosed with HIV in 1985 and was given a year to live.
Mr Martindale said he had been told not to tell anyone, even his family.
He added: “When you’re young you’re invincible, when you’re 23 you’re generally fit, but then you’re told you have 12 months to live – it’s very hard to comprehend, so there was the fear.
“There was no future, the likelihood of getting married and having children was very unlikely.”
Mr Martindale said his brother Richard, who also had haemophilia, was diagnosed with HIV too.
He said his greatest regret was not being able to support his brother in the months before he died in 1990.
Carole Anne Hill found out in January 2017 that she had hepatitis C, infected as a result of a blood transfusion she was given in 1987.
She had menorrhagia at that time, suffering from heavy periods.
Asked how she heard about her diagnosis, she told the inquiry: “By letter, which was half opened and not sealed properly.”
“I was cross about that,” she added.
A number have also been speaking out ahead of the start of the hearing.
Su Gorman said the main thing victims and their families wanted from the inquiry was “justice” and people held to account.
Her husband, Steve Dymond, died aged 62 on 23 December last year of organ failure – ultimately caused by the medicine he was given as a young man.
Steve was born in 1956 with a mild form of haemophilia.
After going to hospital following a minor hand injury in the mid-1980s, he was told he had been treated with Factor VIII that had not been heat-treated.
The concern was that he may have been exposed to HIV. He was given the all-clear but in the 1990s was diagnosed with hepatitis C.
It was only in 2013 that a new drug was approved that could successfully eliminate the hepatitis C virus from Steve’s body.
By then, though, the damage was already done. Scans showed his liver was cirrhotic and a bunch of cells showed the early signs of cancer.
His health declined quickly in the last 18 months of his life.
Su said: “I want to see justice.
“I want to see people called to account, I want to see anybody found to have behaved inappropriately, criminally or negligently made to explain themselves.
“Steve’s dying words were he wanted them to repent. I promised him they would – and that’s a promise I intend to keep.”
Why has it taken so long to have an inquiry?
This is the first UK-wide public inquiry that can compel witnesses to testify.
It comes after decades of campaigning by victims, who claim the risks were never explained and the scandal was subsequently covered up.
The government has been strongly criticised for dragging its heels.
There have been previous inquiries. One was led by Labour peer Lord Archer of Sandwell and was privately funded.
It held no official status and was unable to compel witnesses to testify or require the disclosure of documents.
Meanwhile, the Penrose Inquiry, a seven-year investigation launched by the government in Scotland, was criticised as a whitewash when it was published in 2015.
Greater Manchester Mayor and former Health Secretary Andy Burnham has repeatedly called for a probe into what happened.
Mr Burnham claimed in the House of Commons in 2017 that a “criminal cover-up on an industrial scale” had taken place.
The government announced there would be an inquiry only after it faced a possible defeat in a vote on an emergency motion.
This public inquiry into the scandal was first announced in the summer of 2017.
More money for victims
Ahead of the public hearings, the government announced more financial support for people in England affected by the tragedy, to a total of £75m from £46m, amid complaints other parts of the UK were more generous.
Prime Minister Theresa May said at the time: “The contaminated blood scandal was a tragedy that should never have happened and has caused unimaginable pain and hurt for victims and their families for decades.
“I know this will be a difficult time for victims and their families – but today will begin a journey which will be dedicated to getting to the truth of what happened and in delivering justice to everyone involved.”
But Jason Evans, founder of the campaign group Factor VIII, said the fund was still essentially a “begging bowl” and the increase, about £900 for each victim, represented “virtually no change”.