But as prosecutors began outlining the evidence, Rudakubana interrupted by shouting from the dock that he felt ill and wanted to see a paramedic.

Judge Julian Goose urged lawyers to continue, then ordered the accused to be removed when he continued shouting.

The attack occurred on the first day of summer holidays when two dozen little girls were in a class to learn yoga and dance to the songs of Taylor Swift. What was supposed to be a day of joy turned to terror and heartbreak when Rudakubana, armed with a knife, intruded and began stabbing the girls and their teacher.

He killed Alice Da Silva Aguiar, 9, Elsie Dot Stancombe, 7, and Bebe King, 6. Eight other girls, ranging in age from 7 to 13, were wounded, along with instructor Leanne Lucas and John Hayes, who worked in a business next door and intervened.

Prosecutor Deanna Heer said Rudakubana had no political or religious cause.

“His only purpose was to kill. And he targeted the youngest and most vulnerable in society,” she said, as relatives of the victims watched on.

Heer said that when he was taken to a police station, Rudakubana was heard to say: “It’s a good thing those children are dead, I’m so glad, I’m so happy.”

The crime triggered anti-immigrant rioting and has led the government to reconsider its definition of terrorism, its approach to online radicalisation and the way information about criminal suspects is made public.

The killings in the north-west England town triggered days of anti-immigrant violence across the country after far-right activists seized on incorrect reports that the attacker was an asylum-seeker who had recently arrived in the UK. Some suggested the crime was a jihadi attack, and alleged that police and the government were withholding information.

Rudakubana was born in Cardiff, Wales, to Christian parents from Rwanda, and investigators have not been able to pin down his motivation. Police found documents about subjects including Nazi Germany, the Rwandan genocide and car bombs on his devices.

In the years before the attack he had been reported to multiple authorities over his violent interests and actions.

Home Secretary Yvette Cooper told lawmakers on Tuesday that Rudakubana “was convicted of a violent assault against another child at school” and had multiple contacts with children’s social care, mental health services and police, who were called to his home over his behaviour five times between 2019 and 2022.

He was referred three times to the government’s anti-extremism program, Prevent, when he was 13 and 14.

All of the agencies failed to spot the danger he posed.

The government has declared the case a wake-up call. Prime Minister Keir Starmer said it must lead to “fundamental change” in the way the state protects its citizens, announcing a public inquiry into the failures that allowed Rudakubana to carry out his rampage with a knife he had ordered from Amazon.

He said laws might need updating to combat a “new threat” from violent individuals whose mix of motivations test the traditional definition of terrorism, “acts of extreme violence carried out by loners, misfits, young men in their bedrooms”.

The Crown Prosecution Service has defended the decision not to disclose details before Rudakubana went to court, saying “releasing that information earlier would have put the trial at risk.”

UK contempt of court laws limit what can be reported before trial, in the interests of preventing jury bias.