Blood tests

Blood tests: last 8 results
	29	24	20	16	9	7	25	18
	Dec	Dec	Dec	Dec	Dec	Dec	Nov	Nov		Normal
Hb	80	87	82	103	108	79	86	87		130-180
WBC	1.81	2.07	1.51	2.16	1.6	1.3	1.47	1.76		4.5-10.0
N'phils	0.8	0.99	0.47	0.56	0.47	0.44	0.48	0.46		2.0-7
Plt	47	54	50	60	95	107	187	221		150-450

These results were before a blood transfusion

And these were after

	29	29	24	20	16	9	7	25
	Dec	Dec	Dec	Dec	Dec	Dec	Dec	Nov		Normal
Hb	86	80	87	82	103	108	79	86		130-180
WBC	2.46	1.81	2.07	1.51	2.16	1.6	1.3	1.47		4.5-10.0
N'phils	1.24	0.8	0.99	0.47	0.56	0.47	0.44	0.48		2.0-7
Plt	35	47	54	50	60	95	107	187		150-450

Bloods December 20

Blood tests: last 8 results
	20	16	9	7	25	18	21	5
	Dec	Dec	Dec	Dec	Nov	Nov	Oct	Oct		Normal
Hb	82	103	108	79	86	87	107	95		130-180
WBC	1.51	2.16	1.6	1.3	1.47	1.76	1.8	1.95		4.5-10.0
N'phils	0.47	0.56	0.47	0.44	0.48	0.46	0.57	0.87		2.0-7
Plt	50	60	95	107	187	221	202	225		150-450

Creatinine 172, still way above normal range 45-120, and sharp falls in Hb, WBC, N'phils and Plt.

Lets hope tomorrow is better or it means two pouches of blood.

Bloods December 20

Blood tests: last 8 results
	20	16	9	7	25	18	21	5
	Dec	Dec	Dec	Dec	Nov	Nov	Oct	Oct		Normal
Hb	82	103	108	79	86	87	107	95		130-180
WBC	1.51	2.16	1.6	1.3	1.47	1.76	1.8	1.95		4.5-10.0
N'phils	0.47	0.56	0.47	0.44	0.48	0.46	0.57	0.87		2.0-7
Plt	50	60	95	107	187	221	202	225		150-450

Creatinine 172, still well above normal range of 15-120. Abnormally high levels of creatinine warn of possible malfunction or failure of the kidneys. It is for this reason that standard blood tests routinely check the amount of creatinine in the blood.

Blood tests

Blood tests: last 8 results
	16	9	7	25	18	21	5	18
	Dec	Dec	Dec	Nov	Nov	Oct	Oct	Sep		Normal
Hb	103	108	79	86	87	107	95	106		130-180
WBC	2.16	1.6	1.3	1.47	1.76	1.8	1.95	2.53		4.5-10.0
N'phils	0.56	0.47	0.44	0.48	0.46	0.57	0.87	1.05		2.0-7
Plt	60	95	107	187	221	202	225	2.41		150-450

Nb Creatinin was 297 compared with normal range 45-120

indicating dehydration, so I'm drinking a lot & will have another

blood test tomorrow. Platelets continue to fall but neutrophils are 

above the level of 0.5 µmol/L described as 'severe neutropenia',

Plan B appears to consist of regular blood transfusions and no

medication to replace the hydroxycarbamide.

Haematologists have written to Professor H  the foremost expert

on myelofibrosis to see whether she has any ideas on treatment.

Latest bloods

Blood tests: last 8 results
	9	7	25	18	21	5	18	10
	Dec	Dec	Nov	Nov	Oct	Oct	Sep	Sep		Normal
Hb	108	79	86	87	107	95	106	81		130-180
WBC	1.6	1.3	1.47	1.76	1.8	1.95	2.53	2.39		4.5-10.0
N'phils	0.47	0.44	0.48	0.46	0.57	0.87	1.05	1.02		2.0-7
Plt	95	107	187	221	202	225	2.41	2.41		150-450

Haematology outpatients this morning. There wasn't a Plan B, and obviously there was no suggestion of going back onto hydroxycarbamide. The stopgap plan is to have weekly blood tests, with transfusions if the Hb plummets, as it may well do. The neutropenia doesn't seem to have been affected by stopping the hydroxycarbamide, and the doctor, when asked, didn't have any ideas on medication that would increase the level of neutrophils.

There was a suggestion by one of the haematologists who saw me during my 5 days in hospital that myelofibrosis could be transitioning to leukemia, and I had expected this to be confirmed or otherwise by the blood tests. However it wasn't mentioned in my discharge notes, so the evidence is presumably inconclusive.

Five days in hospital

Last Thursday I woke up with a fever and severe vomiting and was taken to KCH A&E by ambulance. The infection was later identified as coagulase negative staphylococcus. Anti-emetic stopped the vomiting and a broad spectrum antibiotic dealt with the infection. I had two pouches of blood to deal with neutropenia, see below, and was discharged at 23.00 yesterday evening.

There had been some discussion of a bone marrow biopsy to get a better picture of the number of blasts and fibres in the blood, but in the end the haematologists decided against that course of action because of the risks, and because an extra blood test taken December 10 would be likely to give the information necessary for Plan B to replace hydroxycarbamide. Since that medication had been stopped altogether, there hadn't been a rise in the platelets, the original reason for that drug to be prescribed. On the contrary, Plt fell sharply, and other components also went down. Anyway, I've got a regular haematology outpatients tomorrow morning, so it will be a good opportunity to see whether there is a standard answer to the question of how to deal with the appearance of blasts and fibre.

After first thinking that a bone marrow biopsy would be a good idea, the haematogists have had second thoughts because of the risks attached to the procedure. I'm certainly not sorry its unnecessary because its quite painful, though I didn't say so when it was done for the diagnosis in 2011:

THURSDAY, JULY 21, 2011

Last days of term

.....
Tuesday morning I was at King's, to have a bone marrow biopsy to help diagnose the myeloproliferative disorder they think I've got. Its a disorder of the blood, the indicator of which was a platelet count which shot up to over 1,000 compared with the normal 500. After a local anaesthetic a needle is stuck into the pelvis on the right side, leaving no apparent side effects apart from bruising.

,,,,,

Blood tests: last 8 results 10 25 18 21 5 18 10 3 Dec Nov Nov Oct Oct Sep Sep Jul Normal Hb 79 86 87 107 95 106 81 104 130-180 WBC 1.3 1.47 1.76 1.8 1.95 2.53 2.39 2.85 4.5-10.0 N'phils 0.44 0.48 0.46 0.57 0.87 1.05 1.02 1.16 2.0-7 Plt 107 187 221 202 225 2.41 2.41 249 150-450

Well done Mark Zuckerberg

Mark Zuckerberg says that his $45 billion gift to a new charitable foundation [http://bbc.in/1lvqSqo] will be used to promote equality. UK income inequality is among the highest in the developed world and evidence shows that this is bad for almost everyone, see  https://www.equalitytrust.org.uk/. It would be good if our philanthropists would follow the example of donors in the US and do more to combat inequality, but it should also be an explicit goal of our Government's policy

Eritrea-Ethiopia Boundary Commission (EEBC)

This illustrates the reason why the problem of the Eritrea-Ethiopia boundary remains unsolved. The parties agreed beforehand that they would accept the decisions of the Boundary Commission, but Ethiopia reneged on the decision by the EEBC to demarcate the boumdary by coordinates, and the international community including the UK let them off the hook by saying that "there should vbe a dialogue between them about the border". This would imply that after all, the EEBC's determination was not final and binding, and that it could still be adjusted to suit one of the parties.

The only way to break the deadlock and end the confrontation which sterilises a huge area along the border, keeping armies numbering tens of thousands on either side and preventing trade across the frontier, is for the UN Security Council to insist that Ethiopia stand by its undertaking to accept the  EEBC. The UK should be taking the lead on arriving at this solution.

Demonstration outside Parliament by Bangladesh minorities

My letter to Minister Hugo Swire MP:

           

From Lord Avebury                                                                                                     P1524112

November 24, 2015

 Dear Mr Swire,

I attach a letter from the Bangladesh Human Rights Alliance about a demonstration opposite Parliament on November 18 which I attended. As I'm sure you know, although in the past there has been reasonable harmony between the various faiths in Bangladesh including those of no faith, there has been a downward trend in recent years, with violent attacks on persons and property by Islamist terrorists, including the hacking to death of five secular bloggers. The government hasn't been able to bring the perpetrators of these attacks to justice, or to dismantle the terrorist organisations that spread religious hatred. I do understand that we can't tell the Bangladesh government how to deal with these issues but I hope we could tell them of the strong feelings expressed by representatives of the minorities in the diaspora on the subject.

Hugo Swire Esq MP

Foreign & Commonwealth Office,

London SW1P 3BT

How not to eradicate the Daesh

When the Lord Privy Seal Baroness Stowell of Beeston repeated the Prime Minister's statement in the Commons on the G20 and the Paris Attacks last week I asked her if as part of the comprehensive strategy for eliminating the Daesh in Syria the Government would supply armaments and logistics to the YPG (Official Report November 17 Col 58), her answer was:

"We are supporting the moderate opposition groups in the area so that they can combat ISIL and Assad, and we will continue to do that".

Patrick Cockburn writing in The Independent today [http://ind.pn/1IaN4jY] says that the moderate Syrian opposition to Assad 'barely exists'. The effective ground forces combatting the Daesh in Syria are the Syrian army and the Kurdish YPG, and we are risking failure by ignoring the greater  contribution they could make to eradicating the terrorists so-called 'caliphate'

Haematology

Blood test just a week after the previous one:

	25.1	18.1	21.10	5.10	18.09	10.09	3.07	17.06	Normal
Hb	86	87	107	95	106	81	104	107	130-180
WBC	1.47	1.76	1.8	1.95	2.53	2.39	2.85	2.85	4.5-10.0
N'phils	0.48	0.46	0.57	0.87	1.05	1.02	1.16	1.17	2.0-7
Plt	187	221	202	225	2.41	2.41	249	232	150-450

Considering that the Hydroxycarbamide was originally prescribed to reduce the very high Platelets, it was counter-intuitive that they are sharply down a week after knocking off that medication. Maybe it takes a while to kick in, but we'll see in two weeks' time. The Neutrophils are still below the level of 0.5 which defines 'severe neutropenia', see previous post. WBC are at a new low, meaning less resistance to infections.

Anyway, I had one unit blood transfusion at King's College Hospital following the test, and that should at least bring Hb over the 100 mark, still a lot short of the normal range.

I didn't see one of the consultants, so haven't asked about a Plan B, and haven't heard from the ulcer nurse.

Haematology

Blood results

	18.1	121.10	5.10	18.09	10.09	3.07	17.06	9.06	Normal
Hb	87	107	95	106	81	104	107	93	130-180
WBC	1.76	1.8	1.95	2.53	2.39	2.85	2.85	2.55	4.5-10.0
N'phils	0.46	0.57	0.87	1.05	1.02	1.16	1.17	1.14	2.0-7
Plt	221	202	225	2.41	2.41	249	232	296	150-450

October 21 Neutrophils were incorrectly recorded last time, corrected in this post, and they have now fallen below 0.5. Consultant decided I should take a holiday from Hydroxycarbamide for the next three weeks and then review the results again. He thought Hb might also recover a bit, an opinion I don't share. Its at about the level I had the last transfusion, and I will be surprised if I don't need one again after the next test.

I raised the problem of the ulcer on my left ankle, which has continued for 6 months, and the consultant is referring me to the specialist ulcer nurse.

PS Friday 15.00: on returning from the House just now, I found a message on my answerphone asking me to come in next Wednesday for a blood test and possible transfusion. Neutrophil count of less than 0.5 x 10^9/L is classified as severe neutropenia. I've cancelled the meeting I had on statelessness that morning, a second meeting to discuss the UK's policy on Eritrea, and an evening meeting I was scheduled to chair on Gypsies and Travellers.

PPS Letter from consultant to GP (in part):

I note a gradual drop in his white cell count despite the gradual reduction of his Hydroxycarbamide dose. His neutrophil count is 0.46 and he understands that he is neutropenic and he will require prompt medical attention if he should feel unwell or have fevers. We shall withhold Hydroxycarbamide from today.. He is okay with his current level of haemoglobin at 87 but if his symptoms of tiredness worsen he knows to contact us to organise a blood transfusion.

With regard to his chronic leg ulcer I shall write to the tissue viability nurse specialist to organise a clinic review......

We shall review him again in three weeks' time to see if his counts have picked up after stopping the Hydroxycarbamide completely. If there is no further improvement we shall consider doing a bone marrow aspirate/trephine biopsy. I will check his blood film today, to look for any circulating blasts and report back.

With regard to his chronic leg ulcer I shall write to the tissue viability nurse specialist to organise a clinic review......

Blood film showed macrocytosis [see http://1.usa.gov/1kOwKvg}, aniso-poikilocytosis [see http://yhoo.it/1lcju3c}, neutropenia and adequate platelets with no evidence of clumping. (amended: Left shifted neutrophils with occasional myelocyte and circulating blast seen.

--------------------------------------------------------------------------------
The problem with this plan could be that my platelets will go through the roof, the reason why hydroxycarbamide was prescribed in the first place. So far that strategy had worked, juggling the dose after each consultation, but clearly the time has arrived when a Plan B is necessary.

The last sentence in red above does mean that there is an increase in the number of immature leukocytes in the peripheral blood, and the circulating blasts (immature cells) indicate  that the disease is getting to a new stage. The blasts release chemicals that cause the bone marrow to fill with scar tissue, further impairing its ability to produce healthy cells.

The median survival of all patients with myelofibrosis is slightly higher than 5 years, so I have been lucky to get to four and a half years without having to give up working. Anyway, watch this space.

Family graveyard

Today we had lunch with Sue and Lyulph, and visited the family graveyard. Unsurprisingly, as its a small area within land owned by Bromley Council, it hasn't been looked after and is sadly unkempt. The memorial stones to my grandfather and some of his descendants were vandalised at some point in the past, and the ones that could be salvaged were moved into the church graveyard 100 m or so away. Now that I expect to be a new resident in the family patch within nine months or so, we thought it would be good to have it cleared, and for the boundary to be demarcated - by coordinates, I suggest. Lyulph has had some preliminary conversations with Bromley Council and will pursue the matter in the near future.

Sheikh Ali Salman's trial postponed again

 Statement by the main opposition in Bahrain, Al-Wefaq, about Sheikh Ali Salman's trial

The Bahraini regime courts have adjourned the hearing of Sheikh Ali Salman, opposition leader and Secretary General of Al Wefaq National Islamic Society, to December 14 citing reason that only part of the bench attended.

Sheikh Ali Salman was not brought into the court to attend his hearing. Lawyers said this gave negative signals as to the nature of the trial.

Salman is being tried for political activism and expression of political opinion. He was sentenced to four years in prison last June.

The defense team reiterated its requests before the court to allow Sheikh Salman to see the lawsuit papers after the prison administration violated his right to confidentiality of communication with his lawyers, that is, besides standing on the prosecution side and building the case and accusations against him.  

Al Wefaq stressed that the continuation of the trial which was described by international human rights organizations, observers and states, to be lacking the fundamental standards of a fair trial indicates the malicious motives behind the case. It must also be taken into consideration that the defense team was prevented from doing its job prior to the issuance of the sentence and during the appeal process; these facts make certain that the trial is politically-motivated.   

The adjournment of the hearing is aimed to buy time for developments.

Al Wefaq is demanding the immediate and unconditional release of Sheikh Ali Salman who is a patriotic national figure and should not be in jail. The continuation of his trial and imprisonment clearly demonstrates political reprisal, especially as consecutive international calls condemned the arrest.
The statement of the UN Working Group on Arbitrary Detention in which it said Salman is being arbitrarily imprisoned, and the statements made by the Department of State’s spokesperson who called on Bahrain to drop the charges and respect freedom of expression and assembly, make clear that there is no justification for the continuation of his detention. Further, they highlight the fact that the Bahraini Authorities are insisting to walk in the wrong direction.  

Sheikh Ali Salman enjoys a popular position between his people and wide respect by the international community, thus, the authorities should not take uncalculated and reckless decisions. Such vengeful methods only complicate the crisis and move the nation farther away from an inclusive and genuine political resolution. Bahrain needs a comprehensive national review based on the interests of the country and its citizens.

The release of Sheikh Ali Salman would represent the first step to a suitable environment for a real dialogue to reach a political settlement.

Prominent human rights organizations like Amnesty International, Human Rights Watch and the International Federation for Human Rights have all called for the immediate release of Salman, naming him a prisoner of conscience. Bahrain is yet to respond to Prince Zaid, the High Commissioner of Human Rights at the UN, who also urged for Salman’s release.

----------------------------------------------------------------------

I have asked Foreign Office Minister James Duddridge MP to demand Sheikh Ali's unconditional release, as the UN High Commissioner for Human Rights and the US State Department had already done. The UK's policy has always been that Bahrain's constitutional and human rights problems can only be resolved by a meaningful dialogue between government and opposition. This can't happen when the Leader of the Opposition is in custody on trumped-up charges.

London Bach society's 25th anniversary Bachfest, on the Leipzig Inheritance

To St John's Smith Square for a memorable LBS concert, dedicated to the memory of their late and much-loved  cellist Jennifer Ward Clarke, who died in May.

Ach Gott, wie manches Herzeleid (O God, what manifold distress) BWV 58, was followed by Suite No 2 in B minor BWV 1067 with Rachel Beckett on the flute.

After the interval we had Ich habe genug (My cup is full) BWV 82 with Peter Harvey (bass). Listen to him singing the aria Schlummert ein, ihr matten Augen (Fall asleep, weary eyes), one of my all-time favourites: https://www.youtube.com/watch?v=3rUsCB16lw4&list=RD3rUsCB16lw4

And finally, Ich geh' und suche mit Verlangen (I go in search with longing) BWV 49 with Peter Harvey again and Ruby Hughes, soprano.

  

Incorrect advice by the Government on citizenship

A correspondent has drawn my attention to the failure of the Government to post amendments that were made to the British Nationality Act 1981 by Parliament in the Immigration Act 2014 on the official Government website. The amendments were to add Sections 4E to 4J, enabling certain children whose parents weren't married at the time of their birth to acquire British citizenship.

I am tabling a question asking the Government to update the advice on their website, and to amend the site legislation.gov.uk.

It is unacceptable that false information is allowed to remain on the web on such an important matter as entitlement to citizenship.

Investigatory Powers Bill

In 2012 Theresa May and the Tories tabled plans to force internet service providers to keep a record of all your texts, emails and every website you visit.

That was a huge invasion of our privacy, an unprecedented a precursor attempt to get hold of everybody's personal data.

The Liberal Democrats were clear then, and are clear now, a snooper’s charter has no place in Britain, so we blocked it.

Theresa May’s revised plans that are published today are another attempt to sneak these provisions back in again.

The Liberal Democrats will fight any attempt to bring back the so-called Snooper’s Charter under a different name.

In March 2013 Parliament decided to make caste a protected characteristic in the Equality Act, after the Government were defeated twice on the issue in the House of Lords, and there was no time for them to reverse that decision in the Commons before the Dissolution. But they made no secret of their antipathy to the proposal in their dealings with the Hindu Forum, a powerful lobby group which defends the caste system by pretending that discrimination is non-existent in the UK. It would be remarkable if the large diaspora from south Asia had indeed abandoned such a deeply persistent cultural norm in their travels, and in spite of the formidable obstacles to  litigation against caste discrimination under existing equality law, the recent case of Chandhok & Anor v Tirkey demonstrated that in certain limited circumstances, the courts would find in favour of the victims. The Government then said they were studying the implications of the Tirkey judgement and had to 

"consider carefully whether putting the word “caste” into the Act would actually change or clarify the legal position". [ http://bit.ly/1GEGcLd]

The fact is that it would remove the barrier to litigation arising from the wording of the Tirkey judgement, which applied only in the particular circumstances of that case. Victims of caste discrimination would have to satisfy the court that they were covered by that judgement, adding to the burden of proof and to their costs. Legal certainty can only be achieved through the implementation of Parliament's two and a half year old decision, which the Government's 'careful consideration' is a preliminary to repealing. 

The Tories have decided, I fear, that the higher castes represented by the Hindu Council need to be placated at the expense of the Dalits, who are generally the victims of caste discrimination here in the UK, as they are still in south Asia. The Government should tell the Hindu lobby that the Equality Act as amended will protect victims of discrimination no matter what their caste in the situations it covers [http://bit.ly/1Q41WSS]. High caste Hindus have nothing to fear if they refrain from discrimination, and the amendment is no more a criticism of them as a community than the equivalent sections dealing with racial discrimination are aimed at groups of a particular ethnicity.

Useful article in The Economist http://econ.st/1l3dSs5

Saudi Arabia in Yemen: humanitarian disaster and possible war crime

Yemen

Question

11.18 am

Asked by Lord Avebury

To ask Her Majesty’s Government what discussions they have had with the Saudi-led coalition in Yemen on restoring peace in that country.

The Earl of Courtown (Con): My Lords, the United Kingdom Government are in regular contact with the Saudi authorities, including through our embassy in Riyadh and our Yemen office based in Jeddah. The Secretary of State for Foreign and Commonwealth Affairs visited Saudi Arabia earlier this week and underlined the importance that the United Kingdom attaches to finding a political solution to the current crisis as soon as possible. He also reinforced the necessity of full compliance with international humanitarian law and of facilitating access for humanitarian and commercial shipping.

Lord Avebury (LD): My Lords, the Yemen operation has left 5,000 dead, 26,000 injured, 2.3 million internally displaced and 21 million in need of humanitarian assistance. If we agree with the Brookings Institution that al-Qaeda is the principal local winner of this war and with Human Rights Watch that Saudi attacks on IDPs and humanitarian aid are violations of the laws of war, will the Government use our presidency of the Security Council in November to promote a truce and to call for the withdrawal of all foreign forces in Yemen?

29 Oct 2015 : Column 1274

The Earl of Courtown: My Lords, the noble Lord is right: the situation there at the moment is dreadful. In July it was declared a level 3 emergency, which is reserved for the worst humanitarian crises—shared only, I am afraid, by Syria, Iraq and South Sudan. As the noble Lord said, the intensified conflict has now displaced nearly 2.3 million people. He asked whether there is anything that we can do during our presidency of the Security Council. I will pass on his question to my colleagues in the department, but I can say that UN special envoy Ismail Ould Cheikh Ahmed briefed the Security Council in open session on Friday on his plans for further political negotiation. That is something that we are very pleased about.

Lord Anderson of Swansea (Lab): My Lords, does the noble Lord agree that there is a real danger of misreading the situation in Yemen by focusing on the Shia-Sunni divide or on the Saudi-Emirati opposition to Iran and failing to appreciate the fundamental importance of clan and tribal loyalties? Does he also agree that we have a major interest in preventing yet another failed state in the region sending waves of migrants to Europe, adding to the 1 million who have come to our shores over the past year?

The Earl of Courtown: The noble Lord makes a very good point relating to the tribal issues in Yemen that make it increasingly difficult, and always have made it very difficult, to manage. As far as migration is concerned, it is very difficult to compare different areas, and of course this is very different from, for example, Syria. However, we will keep a very close watch on what is happening there.

Baroness Warsi (Con): My Lords, what is the Government’s assessment of the comments made yesterday by the Saudi Foreign Minister, Adel al-Jubeir, who said that the military campaign is now nearing its end?

The Earl of Courtown: My Lords, at last night’s press conference in Riyadh, held jointly with my right honourable friend the Foreign Secretary, the continuing situation in Yemen was discussed. As my noble friend says, it is the case that the military campaign is coming to a close as the coalition forces have established a dominant military position in the country. We now focus on the agreed shared analysis of the need for accelerating the political process.

Baroness Kinnock of Holyhead (Lab): My Lords, will the Minister tell the House exactly why the UK Government continue to license arms to the Saudi-led coalition that is bombing Yemen? As we have heard, more than 5,000 civilians have been killed. Can the Minister give us proof that no British exported weapons, including British-made military planes, are being used to commit violations of humanitarian law?

The Earl of Courtown: My Lords, the noble Baroness, with her great knowledge of this area, asks some questions to which I am afraid I do not know the answer. Munitions are supplied to the Saudi air force, and the UK operates one of the most rigorous and transparent export control regimes in the world.

29 Oct 2015 : Column 1275

Lord Green of Deddington (CB): My Lords, I welcome the Question from the noble Lord, Lord Avebury. As it happens, Yemen was my first post and Saudi Arabia was my last. I suggest to the Minister that we should focus our efforts on the humanitarian aspects here, partly for the reasons given by the noble Lord, Lord Anderson. It is a hugely complex situation, internally in Yemen and externally in the regional powers. The best thing that we can do is to increase our aid to those many millions who are suffering dreadfully.

The Earl of Courtown: The noble Lord, Lord Green, is quite right, in so far as we have to focus the aid so that it gets to the people who need it. However, as the noble Lord is also aware, the logistics of getting it there are proving very difficult.

Lord Ahmed (Non-Afl): My Lords, is the Minister aware that, according to the BBC, war crimes have been committed, probably by both sides, by targeting civilians and world heritage sites, and that on Tuesday, a hospital was bombed as well? Will Her Majesty’s Government support an international investigation into these deliberate attacks on civilians?

The Earl of Courtown: My Lords, as the noble Lord said, issues relating to activities on both sides are causing great concern—whether it is the bombing of a hospital, the use of child soldiers or the use of schools and hospitals for military purposes. But the noble Lord will also be aware that any judgment on whether specific international crimes have occurred is a matter for international judicial decision rather than for Governments and non-judicial bodies.

As far as the Médecins Sans Frontières hospital is concerned, which I think is what the noble Lord was referring to, we are aware of the alleged air strike by the Saudi-led coalition and we await further news on that.

Lord Wallace of Saltaire (LD): My Lords, we must admit that the British record in controlling Aden was not particularly wonderful and that Yemen has never been an entirely coherent state. Britain now prides itself on the closeness of its links with Saudi Arabia and the GCC coalition that is intervening. Can we be assured that conversations with the Saudis on what is happening in Yemen are close and confidential and have not been adversely affected by the recent letter from the Saudi ambassador in London?

The Earl of Courtown: My Lords, we continue at all times, as the noble Lord is aware, to have talks at the highest level on all these issues.

Lord Collins of Highbury (Lab): My Lords, in view of the reports of violations of serious international human rights law committed by parties in Yemen, does the Minister support the establishment of an international commission of inquiry to investigate these allegations?

The Earl of Courtown: My Lords, the UN Human Rights Council, which I think the noble Lord was referring to, has no mandate to call for IHL investigations. Resolutions contain mechanisms for monitoring the

29 Oct 2015 : Column 1276

human rights situation in Yemen. There was recently an agreement on a single text in the Human Rights Council to call for consensual resolution of the position in Yemen.