An unknown number of people have been trapped under rubble after Ukraine’s largest children’s hospital was hit during a daylight Russian missile barrage that the authorities said had killed at least 29 people across the country.

Volodymyr Zelenskiy vowed retaliation as he said Kyiv’s Okhmatdyt hospital, the main treatment centre in the country for children with cancer, had taken a direct missile hit. The strike was part of one of the heaviest attacks on the capital since Russia’s February 2022 invasion.

“Russia cannot be unaware of where its missiles are landing and must be held fully accountable for all its crimes: against individuals, against children and against humanity as a whole” Zelenskiy posted on the Telegram messaging app.

Ihor Klymenko, the interior minister, said five people had been confirmed dead in the Kyiv hospital attack and at least four more had been injured.

The strike largely destroyed the hospital’s toxicology ward. Hundreds of rescue workers and volunteers joined the effort to clear the debris and search for survivors. Officials and emergency staff said it was not immediately clear how many doctors and patients remained trapped under the rubble.

“We are extracting whoever we can. We don’t know the number of people trapped there,” said the health minister, Viktor Liashko, outside the hospital.

Maria Soloshenko, 21, a nurse in the toxicology ward, said hospital staff had been in the process of moving the children to a bomb shelter when the explosion occurred. “There was immediate panic when the strike hit,” she said, her gloves covered in blood.

Soloshenko said children as young as 18 months had to be urgently taken off dialysis and quickly evacuated through the building’s windows.

The Guardian witnessed many young cancer patients in distress during the evacuation, some barely clothed and with medical tubes still attached to them.

Tanya Lapshina, a nurse in the trauma department, where the facade was ripped off by the blast, said they managed to move all the children to a bomb shelter.

She said: “It was complete chaos. The children were in panic, crying in the bunker. There are no words for this. It is awful. I am still shaking.”

Ukraine’s presidential office published an image showing one child with a head injury.

Kyiv’s mayor, Vitali Klitschko, said the attack on the capital was one of the heaviest since Russia’s invasion began more than two years ago. Thanks to western-supplied defences, the city had experienced a relatively peaceful period before Monday’s strike.

Andriy Yermak, the head of the Ukrainian president’s office, shared an image on X that appeared to show a Russian missile over Kyiv moments before it struck a hospital, identifying the rocket as a Kh-101 cruise missile.

The search efforts at the hospital were hindered by air-raid alarms that forced emergency staff to take shelter.

Strikes were also reported in other parts of the country. In Kryvyi Rih, Zelenskiy’s home town, 10 people were killed and 31 were injured, said Oleksandr Vilkul, the mayor. Another three people died in Pokrovsk in eastern Ukraine when missiles hit an industrial facility, said the Donetsk regional governor.

In total at least 29 people across the country were killed, Ukrainian officials said. Zelenskiy said 40 missiles were used in the attack.

Russia, which has targeted civilian infrastructure throughout the war, denied responsibility for deaths on Monday. In a statement, the defence ministry attributed the incident, without directly referencing the hospital blast, to Ukrainian anti-aircraft missiles.

Western leaders strongly condemned the attack. The Italian foreign minister, Antonio Tajani, wrote on X: “I am struck by the images of the bombings in Kyiv which also hit a children’s hospital. War crimes that must be condemned by the entire international community. The [Italian] government will continue to defend the sovereignty of Ukraine and its people.”

The International Rescue Committee said the attack was part of a broader pattern of Russian strikes on medical facilities since the invasion.

“No child should grow up under the threat of missile strikes. No child should risk dying amid the rubble of hospitals meant to be safe havens for healing and recovery,” the IRC said in the statement. “Since the beginning of the full-scale invasion, the WHO [World Health Organization] has recorded nearly 1,700 attacks on healthcare facilities in Ukraine.”

The strikes on Monday occurred a day before Nato leaders are due to meet in Washington for their yearly summit, where they are expected to announce new measures to boost Ukraine’s air defence capabilities.

During a press conference in Warsaw after a meeting with the Polish prime minister, Donald Tusk, Zelenskiy urged Kyiv’s allies to make a decisive response to the attack.

“I would also like to hear from our partners [about] a greater resilience and a strong response to the blow that Russia has once again dealt to our people, to our land, to our children,” he said, adding that he was waiting for concrete steps from the west to strengthen Ukraine’s air defences and protect its energy sector.

Joe Biden came out swinging Monday against critics of his calamitous June debate performance, telling Democrats in an open letter and Americans in a pugnacious live TV interview he is staying in the presidential race – rejecting growing calls to concede that at 81 he is too old and ineffective to beat Donald Trump, and should drop out in favour of a younger candidate.

The president lashed out at “elites in the party” in a live telephone interview with the MSNBC show Morning Joe, saying he said they were behind calls for him to quit. He added: “If any of these guys don’t think I should run, run against me. Go ahead. Announce for president – challenge me at the convention!”

Touting what he said was a demanding campaign schedule around his hosting of a Nato summit this week, the president insisted: “The American public is not going to move away from me.

“I’m here for two reasons, pal. One, to rebuild the economy for hard-working middle class people, to give everybody a shot. It’s a straight shot. Everybody gets a fair chance. Number two, people always talk about how I don’t have the wide support. Come on, give me a break. Come with me. Watch.”

Concerns about Biden’s fitness have dogged him throughout his time in office, but they exploded into open view late last month after the first of two scheduled debates with Trump.

Onstage in Atlanta on 27 June, Biden appeared hesitant, confused and physically diminished, struggles aides put down to a cold and jet lag.

In comparison, Trump spewed lies virtually unchecked by his opponent or CNN moderators working to rules that precluded instant fact checks.

The result was a disaster for Biden, a polling bump for Trump and panic among Democrats.

By Monday, nine House Democrats had called for Biden to quit. Damagingly, senior representatives Jerry Nadler of New York and Adam Smith of Washington were among those to call for him to go. A reported move towards a similar call in the Senate did not produce a result.

Biden insisted to MSNBC that his poor debate display was down to health issues.

“I was feeling so badly before the debate,” he said. “They tested me, they thought maybe I had Covid, maybe there was something wrong, an infection or something. They tested me, they gave me those tests. I was clear. So, I had a bad night.”

Touting public appearances since the debate, Biden said they showed he was in vigorous health and out meeting voters more than Trump, who has kept a lighter schedule.

“I have a neurological test every single day sitting behind his desk and making these decisions,” Biden told MSNBC.

“You know it, they know it. I’m not bad at what I do.”

Biden’s open letter to Democrats returning to Washington after the 4 July congressional recess was released just before he spoke to MSNBC.

In the letter, the president said he was “firmly committed to staying in this race, to running this race to the end, and to beating Donald Trump”.

He also claimed that in “extensive conversations with the leadership of the party, elected officials, rank and file members and most importantly Democratic voters over these past 10 days or so”, he had “heard the concerns that people have – their good faith fears and worries about what is at stake in this election. I am not blind to them.

“Believe me, I know better than anyone the responsibility and the burden the nominee of our party carries. I carried it in 2020 when the fate of our nation was at stake.”

Biden defeated Trump handily then. But on inauguration day, he was 78 – as old as Trump is now but the oldest man ever to take the presidential oath.

On MSNBC and in his open letter, Biden sought to focus on Trump.

“I wouldn’t be running again if I did not absolutely believe I was the best person to beat Donald Trump,” he wrote.

So deep into an election year, it is unclear what Democratic party mechanism could be used for replacing Biden, whether with his vice-president, Kamala Harris, or one of a number of state governors.

In his letter, Biden pointed to his easy primary win over Dean Phillips, a Minnesota representative who campaigned on the issue of Biden’s age. The president also pointed to the independent Robert F Kennedy Jr, who threatens to take votes in battleground states.

“Do we now just say this process didn’t matter?” Biden asked. “That the voters don’t have a say?

“I decline to do that. I feel a deep obligation to the faith and the trust the voters of the Democratic party have placed in me to run this year. It was their decision to make. Not the press, not the pundits, not the big donors, not any selected group of individuals, no matter how well intentioned. The voters – and the voters alone – decide the nominee.

“How can we stand for democracy in our nation if we ignore it in our own party? I cannot do that.

I will not do that.”

Biden said he had “no doubt” he would beat Trump, touting his achievements in office. He also said that in a second term, with a Democratic-controlled Congress, he would restore abortion rights by enshrining them in law, while bringing “real supreme court reform” – an ambitious statement, given a Senate map highly favourable to Republicans.

Finally, Biden said he was “standing up for American democracy”.

His letter invoked the January 6, 2021 US Capitol attack carried out by supporters of Trump, saying his White House predecessor “has proven that he is unfit to ever hold the office of president. We can never allow him anywhere near that office again. And we never will.

“We have 42 days to the Democratic convention and 119 days to the general election. Any weakening of resolve or lack of clarity about the task ahead only helps Trump and hurts us. It is time to come together, move forward as a unified party, and defeat Donald Trump.”

Emmanuel Macron has asked Gabriel Attal to stay on temporarily as French prime minister to maintain stability after a snap general election left France facing a hung parliament and fraught negotiations to form a new government.

The president called the ballot last month after a humiliating defeat to the far-right National Rally (RN) of Marine Le Pen in European parliamentary elections, but on Sunday it was a green-left alliance that emerged as the surprise winner.

The New Popular Front (NFP) won 182 seats in the 577-seat national assembly, with Macron’s centrist Together coalition returning 168 deputies and the RN – which after the first round on 30 June had been eyeing a majority – finishing third on 143.

With no single group securing an outright majority, the options include a technocratic government of experts, the NFP trying to form a minority government and seeking bill-by-bill support, or a broad coalition of the centre left and centre right.

Attal presented his resignation on Monday morning after Macron’s camp lost more than a third of its MPs. The president asked Attal to remain in power in a caretaker capacity to see out the period of the Paris Olympics and to reassure the international community and markets that France still has a functioning government.

The unprecedented situation unfolded as Macron, who said he would wait until parliament was “structured” before making any decisions on a new government, was due to leave the country on Wednesday for a Nato summit in Washington.

Attal had earlier said he would be willing to stay on in a caretaker role for as long as necessary to help oversee a smooth transition to a new government, if one can be found in a parliament that is split into opposing blocs. Macron asked him to remain “for the time being, to ensure the country’s stability”, the Élysée palace said.

Gaël Sliman, of the pollster Odoxa, asked: “Is this the biggest crisis of the Fifth Republic? Emmanuel Macron wanted clarification with the dissolution, now we are in total uncertainty. A very thick fog.” France’s Fifth Republic was founded in 1958.

The Green leader, Marine Tondelier, one of a number of NFP figures seen as potential future prime ministers, said: “According to the logic of our institutions, Emmanuel Macron should today officially invite the NFP to nominate a prime minister.”

While the NFP’s leaders met again on Monday to try to agree a way forward, the leftist alliance appeared divided on how to proceed, with Jean-Luc Mélenchon, the leader of the radical-left France Unbowed (LFI), ruling out any coalition deal with centrists.

Mélenchon’s lieutenant Manuel Bompard confirmed the party’s line on Monday. “The president must appoint as prime minister someone from the NFP, to implement the NFP’s programme, its whole programme and nothing but its programme,” he said.

Raphaël Glucksmann, a moderate who led the Socialist party list in the European elections, said on Sunday that the NFP must be open to dialogue and compromise with other parliamentary groups to govern, but Bompard refused to engage with that possibility.

Tondelier said the prime minister could be someone from any of the NFP’s four member parties or an outsider. Olivier Faure, the Socialist party leader, said a name would be presented this week but declined to speculate about coalitions.

Very little of the NFP’s radical economic programme, which includes raising the minimum wage, reversing Macron’s pension changes and capping the prices of key goods, would win parliamentary approval without coalition support.

Prominent centrists including the former prime minister Édouard Philippe and the long-term Macron ally François Bayrou have said they would be in favour of a coalition agreement stretching from the moderate left to the centre right, but excluding Mélenchon’s LFI.

“We can no longer have one bloc against another – it can’t work like that any more,” Bayrou said on Monday. “French voters have told us that we have to abandon, as far as we can, government ‘against the rest’ for government ‘with the rest’.”

Yaël Braun-Pivet, an MP from Macron’s camp and the outgoing speaker of the lower house, said voters were telling her that “no one has an absolute majority, so you have to work together to find solutions to our problems”.

The left’s surprise victory came after an anti-far-right “republican front” formed to avoid splitting the vote in three-way races in hundreds of constituencies. Le Pen denounced the strategy as unfair, but a senior RN member said the party had work to do.

“We cannot carry on like this,” Bruno Bilde, an RN deputy from northern France, told Le Monde, arguing that the party could “complain all it likes about the unfair system but when so many candidates lose you have to question the candidates’ credibility”.

For more than 50 years, whenever France held a parliamentary election, voters would know the next morning which party would be in government and with what political agenda.

This time it is different. After Emmanuel Macron called a surprise snap election, and after the shortest campaign in modern history, French people delivered a spectacular rush of tactical voting to hold back a surge of far-right support. The resulting political landscape is divided and the outcome is complicated. Macron will take time to let the dust settle, his entourage has said.

An alliance of parties on the left, the New Popular Front, surprised pollsters by coming first with a strong result of 182 seats. But it fell significantly short of the absolute majority of 289 that would allow it to instantly form a government. This means the eurozone’s second largest economy, which is also the EU’s biggest military power, is entering a period of uncertainty with no clear roadmap, less than three weeks before it hosts the Olympic Games.

It could take weeks of dialogue and potential coalition-building to come up with a government and a prime minister. But France – with a powerful president and conflictual political system where parties reach vicious standoffs – does not have a recent tradition of building coalitions.

The French parliament is now roughly split into three blocs. In the lead is the New Popular Front, which blindsided Macron and the opposition when it managed to swiftly and efficiently unite four weeks ago to counter the far right. It is a rainbow grouping that in parliament will run from the firmly leftwing France Unbowed (LFI), which has the greatest number of seats at 74, to the Greens, who increased their seats to 28, through to the more centrist Socialist party, which significantly increased its seats to 59.

The broad left alliance’s deliberately strident policy manifesto included capping prices of essential goods such as fuel and food, raising the minimum wage, reversing Macron’s increase in the pension age to 64 and imposing a wealth tax.

It took care not to push forward one leader during the campaign. Jean-Luc Mélenchon, the veteran leftwinger and firebrand orator who founded LFI, regularly made TV appearances during the campaign. But each time he did, other parties in the alliance would carefully state that he was not in charge and was not necessarily their choice for prime minister.

The Green leader, Marine Tondelier, on Monday called for a calming consensus figure to be proposed as prime minister. It is uncertain how the parties on the left will choose a figurehead, and who it could be.

Macron’s centrist grouping finished in second place on 168 seats, only 14 seats behind the New Popular Front. The centrists, previously in government, lost 80 seats amid voters’ clear anger and rejection of Macron. But the president’s entourage immediately pointed out that although they were reduced in number, they were still standing.

Beaten back into third place came Marine Le Pen’s far-right, anti-immigration National Rally (RN) and its allies with an unprecedented 143 seats.

The key takeaway of the election’s final round is the renewed strength of the French tradition known as the “republican front”, in which voters from all backgrounds group together in tactical voting to hold back the far right.

In the space of one week, the far-right party and its allies went from a first round in which it topped the vote in more than half of the constituencies in France and was within reach of forming a government, to being knocked back into third position in the second round.

The left is now fearful of writing off the far right too quickly. The RN improved from the 89 seats it won in June 2022 to a historic 126. It expanded its presence to new areas such as the Dordogne in the south-west. Le Pen said victory had simply been deferred. She will now focus on the presidential campaign of 2027. The party leadership will face a reckoning over its strategy and haphazard vetting of candidates, one of whom dropped out after photos circulated of her wearing a Nazi cap.

The Socialist party leader, Olivier Faure, recognised the fractured and bruised nature of French society after a divisive campaign. For many on the left, the immediate priority is to address key issues for Le Pen’s millions of voters, including the cost of living and poor access to public services in rural and peripheral areas. This is essential if the left is to present a credible alternative and continue to hold the back the far right’s slow but steady rise.

Constitutionally, it is possible for a group in parliament to govern without an absolute majority. But to do this, that group would have to ensure that opposition forces do not club together to form a majority of 289 to vote them down.

The first session of the new parliament is on 18 July. It may be that only then will possibilities for coalitions become fully clear.

More than 1 million people were without power after Hurricane Beryl made landfall outside Houston as a category 1 storm at about 4am on Monday.

Beryl had been downgraded to a tropical storm later Monday morning.

Before making landfall in Texas, the storm had already carved a path through the Caribbean as a category 5 hurricane, where it killed 11 people. It continued on to Mexico’s Yucatán peninsula as a category 2, temporarily dropped in intensity to a tropical storm but again strengthened to a hurricane over the weekend.

The storm, which approached Texas with sustained winds of 75mph (120km/h), was moving north-west at 10mph and made landfall near Matagorda, a coastal town about 95 miles south of Houston, according to the US National Weather Service (NWS).

A tornado watch was in place for an area covering more than 7 million people, according to the Storm Prediction Center. The storm is expected to weaken to a tropical storm and then to a depression as it moves inland along eastern Texas, into the Mississippi Valley and then the Ohio Valley.

“Beryl’s moving inland but this is not the end of the story yet,” said Jack Beven, a senior hurricane specialist at the National Hurricane Center.

Besides power outages, among Beryl’s early impacts was the inundation of parts of coastal Texas, where residents had boarded up windows and beach towns were ordered to evacuate. There are already widespread power outages, according to CenterPoint Energy.

The police department in Rosenberg, Texas, about 50 miles inland, wrote on X that crews were conducting water rescues while navigating downed trees.

Texas officials said they were concerned that few people headed warnings to leave ahead of the storm’s arrival.

Dan Patrick, the state’s lieutenant governor, said: “One of the things that kind of triggers our concern a little bit, we’ve looked at all of the roads leaving the coast and the maps are still green. So we don’t see many people leaving.”Patrick is serving as the acting governor while Texas’s governor, Greg Abbott, is traveling overseas.

More than 120 counties were under disaster declaration on Sunday after statements from Patrick that Beryl was a “serious threat to Texans”.

The storm and accompanying power outages come as temperatures around coastal Texas are forecast at above 90F (32C) in the coming days, including heat indices as high as 108F (42C) on Sunday.

The National Hurricane Center has issued frequent updates as the storm approached, after Beryl caused devastation in the Caribbean as the earliest category-5 hurricane to form in the Atlantic on record.

Scientists warned Beryl’s arrival and peak strength are ominous signs in what is expected to be a hyperactive hurricane season.

Extraordinarily hot sections of the Atlantic Ocean, caused by the burning of fossil fuels, helped supercharge Beryl from a tropical depression into a category 4 storm in just two days, before it strengthened further to a maximum category 5 event.

The Caribbean Sea, the region where Beryl has caused devastation, has already reached peak temperature about three months early, which is “absolutely crazy” according to Brian McNoldy, a climate scientist at the University of Miami.

Hotter water provides fuel for hurricanes, while extra moisture in the air helps unleash larger rain events, and both of these things are being caused by the climate crisis, resulting in fiercer, faster-developing storms. Last year was the hottest for the oceans, globally, ever recorded.

“Beryl would be pretty astounding to happen anyway, but for it to form in June is completely unprecedented,” McNoldy said. “It’s just remarkable to see sea temperatures this warm.”

A hurricane season stretching until November is expected to deliver eight to 13 hurricanes, much more than the usual seven, according to the National Oceanic and Atmospheric Administration.

“Beryl is a worrying omen for the rest of the season,” McNoldy said. “This won’t be the last of these storms.”

In Texas on Sunday, the port of Corpus Christi was closed because of expected gale-force winds. And other ports along the state’s coast, principally serving the oil industry, also started to close or restrict vessel traffic.

Elon Musk’s SpaceX, which has a launch site on South Padre island, said via a Nasa post on YouTube that cranes had lowered and the Ship 31 rocket had been rolled back to the production site in preparation for the storm’s arrival.

According to the National Oceanic and Atmospheric Administration, 109 tropical systems have made landfall in Texas since 1850. The most recent was Hurricane Nicholas, a category 1 hurricane, which killed two people and caused $1bn in damage.

Hurricane Harvey devastated the Houston area in 2017.

Reuters and Associated Press contributed to this report

The leader of a Kenyan doomsday cult has gone on trial on charges of terrorism over the deaths of more than 400 of his followers in a macabre case that shocked the world.

The self-proclaimed pastor Paul Nthenge Mackenzie appeared in court in the Indian Ocean port city of Mombasa along with 94 co-defendants.

Journalists were removed from the courtroom shortly after the start of the hearing to enable a protected witness to take the stand.

Mackenzie, who was arrested in April last year, is alleged to have incited his acolytes to starve to death in order to “meet Jesus”.

He and his co-accused all pleaded not guilty to the charges of terrorism at a hearing in January.

They also face charges of murder, manslaughter, kidnapping, and child torture and cruelty in separate cases.

The remains of more than 440 people have been unearthed so far in a remote wilderness inland from the Indian Ocean coastal town of Malindi, in a case that has been dubbed the “Shakahola forest massacre”.

Autopsies have found that while starvation appeared to be the main cause of death, some of the victims – including children – were strangled, beaten or suffocated.

Previous court documents also said that some of the bodies had had their organs removed.

Mackenzie, a former taxi driver, turned himself in on 14 April last year after police acting on a tipoff first entered Shakahola forest, where mass graves have been found.

In March, the authorities began releasing some victims’ bodies to distraught relatives after months of painstaking work to identify them using DNA.

Questions have been raised about how Mackenzie, a self-styled pastor with a history of extremism, managed to evade law enforcement despite his prominent profile and previous legal cases.

The interior minister, Kithure Kindiki, last year accused Kenyan police of being lax in investigating the initial reports of starvation.

“The Shakahola massacre is the worst breach of security in the history of our country,” he told a senate committee hearing, vowing to “relentlessly push for legal reforms to tame rogue preachers”.

The state-backed Kenya National Commission on Human Rights in March criticised security officers in Malindi for “gross abdication of duty and negligence”.

The president, William Ruto, has vowed to intervene in Kenya’s homegrown religious movements.

In largely Christian Kenya, the saga has thrown a spotlight on failed efforts to regulate unscrupulous churches and cults that have dabbled in criminality.

The leader of a Kenyan doomsday cult has gone on trial on charges of terrorism over the deaths of more than 400 of his followers in a macabre case that shocked the world.

The self-proclaimed pastor Paul Nthenge Mackenzie appeared in court in the Indian Ocean port city of Mombasa along with 94 co-defendants.

Journalists were removed from the courtroom shortly after the start of the hearing to enable a protected witness to take the stand.

Mackenzie, who was arrested in April last year, is alleged to have incited his acolytes to starve to death in order to “meet Jesus”.

He and his co-accused all pleaded not guilty to the charges of terrorism at a hearing in January.

They also face charges of murder, manslaughter, kidnapping, and child torture and cruelty in separate cases.

The remains of more than 440 people have been unearthed so far in a remote wilderness inland from the Indian Ocean coastal town of Malindi, in a case that has been dubbed the “Shakahola forest massacre”.

Autopsies have found that while starvation appeared to be the main cause of death, some of the victims – including children – were strangled, beaten or suffocated.

Previous court documents also said that some of the bodies had had their organs removed.

Mackenzie, a former taxi driver, turned himself in on 14 April last year after police acting on a tipoff first entered Shakahola forest, where mass graves have been found.

In March, the authorities began releasing some victims’ bodies to distraught relatives after months of painstaking work to identify them using DNA.

Questions have been raised about how Mackenzie, a self-styled pastor with a history of extremism, managed to evade law enforcement despite his prominent profile and previous legal cases.

The interior minister, Kithure Kindiki, last year accused Kenyan police of being lax in investigating the initial reports of starvation.

“The Shakahola massacre is the worst breach of security in the history of our country,” he told a senate committee hearing, vowing to “relentlessly push for legal reforms to tame rogue preachers”.

The state-backed Kenya National Commission on Human Rights in March criticised security officers in Malindi for “gross abdication of duty and negligence”.

The president, William Ruto, has vowed to intervene in Kenya’s homegrown religious movements.

In largely Christian Kenya, the saga has thrown a spotlight on failed efforts to regulate unscrupulous churches and cults that have dabbled in criminality.

Donald Trump’s “preposterous” efforts to disavow Project 2025, a rightwing blueprint for a radical takeover of the US government if the former president is re-elected in November, have been derided by former Republican figures.

The Project 2025 plan includes calls for replacing civil servants with Trump loyalists, eliminating the education department, putting the justice department under the president’s thumb and banning the abortion pill.

Democrats have made concerted efforts to say the 900-plus page document from the conservative Heritage Foundation thinktank would be representative of a second Trump presidency.

But although it was written by former members of Trump’s first administration, and he regularly echoes its policies in his speeches, last week Trump tried to disown the initiative.

Posting on his Truth Social website, the presumptive Republican nominee claimed to “know nothing about Project 2025” and have “no idea who is behind it”.

He added: “I disagree with some of the things they’re saying and some of the things they’re saying are absolutely ridiculous and abysmal. Anything they do, I wish them luck, but I have nothing to do with them.”

Olivia Troye, a former White House adviser to Mike Pence who sat in on policy sessions during Trump’s first presidency, said Trump’s attempt to distance himself from Project 2025 was driven by a recognition that its deeply controversial policy prescriptions could sink his election bid.

“This is preposterous if you look at the collaborators and the authors of this plan,” she told CNN when asked whether Trump’s denial was credible. “A lot of these people…served in Trump’s cabinet during his administration. There are people that I worked with. I sat in those policy meetings with them.”

Troye identified various figures – including John McEntee, who was Trump’s director of White House personnel, Stephen Miller, a senior adviser in his first administration, Ben Carson, the housing and urban development secretary in his cabinet, and Ken Cuccinelli, a former deputy secretary of homeland security – as among the project’s leading architects.

Carson has been “out there on the campaign trail” with Trump, she noted.

“I think what this is telling us is that Donald Trump knows that what is written in this plan is so extreme that it is damaging to his possibility of getting elected, and that’s what he’s concerned about.”

“Exactly how do you ‘disagree’ with something you ‘know nothing about’ or ‘have no idea’ who is behind, saying or doing the thing you disagree with?” said former RNC Chairman and current MSNBC host Michael Steele in echoing Troye’s derision.

“And how exactly don’t you know that Project 2025 director Paul Dans served as your chief of staff at the Office of Personnel Management, and associate director Spencer Chretien served as your special assistant and associate director of presidential personnel?”

Among the plan’s more drastic proposals are to fire thousands of permanent civil servants and replace them with hired conservative Trump loyalists, dismantling the federal education department, asserting presidential power over the Department of Justice – which is nominally independent – and a ban on the abortion pill.

The Democrats, currently in the throes of a fierce internal debate over whether to retain Joe Biden as their presidential candidate, have settled on trying to make Project 2025 a household phrase in a drive to illustrate what a second Trump presidency would mean.

Troye said the project should be seen as a threat not just to Democrats but to moderate conservatives, too.

“If you go through and really read through this plan, this is complete overreach by the federal government on our individual liberties,” she said.

“[It talks] about law enforcement and how they’re going to use federal law enforcement in local states and local cities … with no oversight. Because there’s no oversight when they do that. They’ve learned all the lessons during the first Trump term, and that is what is frightening here. I think we need to be paying attention to this, and no amount of distancing by Donald Trump should be believed …I sat in [on] policy-making meetings with these people.”

Trump surrogates have tried to back up his effort to separate himself from the project, with Marco Rubio, a Republican senator from Florida who has been touted as a possible running mate for Trump, claiming in a Sunday interview with CNN that there was no connection between Project 2025 and Trump.

“Thinktanks do thinktank stuff. They come up with ideas, they say things,” he said. “But our party’s candidate for president is Donald Trump.”

He also dismissed the importance of comments by the Heritage Foundation’s president, Kevin Roberts, who said in an interview with Steve Bannon’s War Room podcast last week that conservative-driven “second American revolution” will be bloodless “if the left allows it to be”, viewed by many Democrats as an implied threat of political violence.

“He’s not running for president,” Rubio said. “Our candidate’s Donald Trump. I didn’t see Donald Trump say that.”

The denials appear to be undermined by close studies of the personnel involved in the document’s formulation.

Of the 38 people involved in the writing and editing of Project 2025, 31 of them were nominated to positions in Trump’s administration or transition team – meaning 81% of the document’s creators held formal roles in Trump’s presidency.

The daughter of Nobel prize winner Alice Munro, Andrea Robin Skinner, has alleged that her stepfather sexually abused her as a child, and that her mother stayed with him even after he admitted to the abuse.

Skinner revealed the allegations in an essay and a news article in Canada’s Toronto Star on the weekend, writing about how her stepfather, Gerald Fremlin, began sexually assaulting her in 1976 when she was nine years old and he was in his 50s.

She alleged that Fremlin got into a bed where she was sleeping at her mother’s home in Clinton, Ontario, and sexually assaulted her. Skinner told her father, James Munro, who she says did not tell Munro.

Over the following years, Skinner says Fremlin propositioned her, exposed himself to her, and “told me about the little girls in the neighbourhood he liked”. Skinner said he stopped assaulting her when she became a teenager, but she developed bulimia, insomnia and migraines, which she attributed to the abuse.

In 2005, Skinner went to the police. Fremlin, then 80, was charged with indecent assault against Skinner and pleaded guilty. He received a suspended sentence and two years’ probation. Munro stayed with Fremlin until he died in 2013.

Munro, who was regarded as one of the greatest short-story writers of all time and won the Nobel prize for literature in 2013, died last month at the age of 92.

Skinner wrote that she first told her mother about the abuse in 1992, when she was in her 20s, writing her mother a letter after Munro voiced sympathy for a character in a story who was sexually abused by her stepfather.

However, Skinner said that Munro “reacted exactly as I had feared she would, as if she had learned of an infidelity”.

Munro temporarily left Fremlin, who admitted in letters to the abuse but blamed it on Skinner. “If the worst comes to worst I intend to go public,” he wrote, according to Skinner. “I will make available for publication a number of photographs, notably some taken at my cabin near Ottawa which are extremely eloquent … one of Andrea in my underwear shorts.”

“She said that she had been ‘told too late,’ … she loved him too much, and that our misogynistic culture was to blame if I expected her to deny her own needs, sacrifice for her children and make up for the failings of men,” Skinner wrote. “She was adamant that whatever had happened was between me and my stepfather. It had nothing to do with her.

“I … was overwhelmed by her sense of injury to herself. She believed my father had made us keep the secret in order to humiliate her. She then told me about other children Fremlin had ‘friendships’ with, emphasising her own sense that she, personally, had been betrayed. Did she realise she was speaking to a victim and that I was her child? If she did, I couldn’t feel it.”

Skinner distanced herself from her family in 2002, after telling Munro she would not allow Fremlin near her children. But after reading an interview where Munro spoke positively about her marriage, Skinner took Fremlin’s letters to the police in 2005.

“He described my nine-year-old self as a ‘homewrecker,’” she wrote, adding that he accused her of invading his bedroom “for sexual adventure”.

“The silence continued” even after Fremlin’s death, Skinner wrote, because of her mother’s fame.

“I also wanted this story, my story, to become part of the stories people tell about my mother,” she wrote. “I never wanted to see another interview, biography or event that didn’t wrestle with the reality of what had happened to me, and with the fact that my mother, confronted with the truth of what had happened, chose to stay with, and protect, my abuser.”

People in Gaza City have reported one of the heaviest attacks by Israeli forces since 7 October, sending thousands of Palestinians fleeing from an area already ravaged in the early weeks of the nine-month-old war.

The latest Israeli incursion into the eastern sector of Gaza City came as Israel’s far-right coalition parties threatened again to stop ongoing negotiations in Qatar for a ceasefire, arguing that halting the fighting now would be a huge mistake.

Sporadic militant activity has hindered Israeli efforts to maintain control in Gaza. Despite claiming authority over the Gaza City area months ago, Israel has had to contend with persistent pockets of resistance, forcing a re-evaluation of its military strategy and redeployment of forces.

Before the recent offensive, the Israeli military said it had issued evacuation orders in the targeted zone.

The territory’s civil emergency service told Reuters it believed that dozens of people had been killed in Gaza City but that teams were unable to reach them because of offensives in a number of areas.

Local sources said Israeli warplanes had bombed a residential apartment near an industrial junction south of Gaza City, killing two citizens and wounding five others. They said a house south of Gaza City was bombed, killing one person and wounding seven others.

“Eyewitnesses said that thousands of citizens were displaced from areas south-west of the city towards the north-west and spent the night on the streets without shelter,” a source said.

Sayeda Abdel-Baki, who was sheltering at her relatives’ home in the Daraj neighbourhood of Gaza City, told Associated Press: “We fled in the darkness amid heavy strikes. This is my fifth displacement.”

Medics at al-Ahli Arab Baptist hospital in Gaza City had to evacuate patients to the already crowded and under-equipped Indonesian hospital in the northern Gaza Strip, Palestinian health officials said.

According to an Israeli military statement, Israeli forces were operating “following intelligence indicating the presence of Hamas and Islamic Jihad terrorist infrastructure, operatives, weapons and investigation and detention rooms, including in the Unrwa headquarters”.

Philippe Lazzarini, the commissioner general for Unrwa, the UN’s agency for Palestinian refugees, has previously criticised Hamas and Israel for occupying and using its facilities during the conflict.

Hopes among Gaza residents of a pause in the fighting had revived after Hamas accepted a key part of a US ceasefire proposal, prompting an official in the Israeli negotiating team to say there was a real chance of a deal.

However, the Israeli finance minister, Bezalel Smotrich, who heads a pro-settler party that is part of Benjamin Netanyahu’s governing coalition, said stopping the war now would be a huge mistake.

“Hamas is collapsing and begging for a ceasefire,” Smotrich wrote on X. “This is the time to squeeze the neck until we crush and break the enemy. To stop now, just before the end, and let him recover and fight us again, is a senseless folly.”

Concerns are growing in Israel over the substantial influence wielded by the far-right opponents of a ceasefire deal in the coalition.

Netanyahu is facing criticism from opposition parties, media and families of Israeli hostages, who accuse him of undermining efforts to reach a ceasefire and secure the release of the hostages for his own political survival.

On Monday, a senior Hamas official accused Netanyahu of stepping up combat and bombardment in Gaza in order to derail the latest truce effort. “Whenever a round of negotiations begins and a breakthrough is within reach, he disrupts it all and escalates the aggression and massacres against civilians,” the Hamas official told Agence France-Presse.

Netanyahu’s popularity plummeted after the 7 October attack by Hamas, which exposed serious flaws in Israeli security. Most political observers say he would lose elections if they were held now.

This is not the first time that far-right parties within the coalition have interfered with negotiations.

Dahlia Scheindlin, a political analyst and author of The Crooked Timber of Democracy in Israel, said: “It’s natural that the far-right parties have influence over Netanyahu’s decisions. They are his coalition partners and they were voted into that position. It would be strange if they didn’t have influence over Netanyahu. In addition, the war cabinet is gone and Netanyahu has a poor relationship with his defence minister and is suspicious of the military establishment. Any influence they have is certainly matched by the partners Netanyahu chose for his government.

“The unusual background is that Netanyahu didn’t really have a choice of coalition partners in 2022 because he had been indicted … So no other parties would join his government. When people elected this government in 2022, they weren’t expecting a war of this magnitude … they didn’t know that they were choosing leaders for this purpose.”

On Sunday, Netanyahu’s office issued a document saying any deal must allow Israel to resume its offensive “until it reaches its war goals”.

The document was heavily criticised by the opposition leader, Yair Lapid, who said: “What good does this do? We are at a crucial moment in the negotiations, the lives of the hostages depends on this. Why make such taunting announcements? How does this help the process?”

AFP, AP and Reuters contributed to this report

When he heard a hospital in Karachi was setting up a milk bank for babies, the news was a “huge relief” to Mohammad Munawwar.

With his wife very sick and their premature son Ayan in hospital, the 52-year-old father had had to collect milk five or six times a day from different female relatives who were breastfeeding their own babies.

His elation was short-lived; last month the bank closed before a single ounce could be deposited after complaints from Islamic clerics. Doctors who had been working on the bank for more than 12 months share Munawwar’s disappointment.

“We had been working on the bank [for] a year and had been in intense discussions with the religious clerics from Jamia Darul Uloom Karachi [for] the last eight months,” said Dr Jamal Raza, executive director of the Sindh Institute of Child Health and Neonatology (SICHN), which had established what should have been the first-ever milk bank in Pakistan, in collaboration with Unicef.

He said the scholars had raised several concerns, all of which were addressed, and after finally getting a nod from the seminary, the bank was inaugurated on 12 June.

But the seminary has now withdrawn its fatwa of assent, saying it had new advice that the hospital would find it not only “difficult but almost impossible to adhere to the strict conditions” set down by the institution’s clerics.

“The objective of the doctors who wanted to set up the human milk bank may be in good faith, but we concur with Jamia Darul Uloom Karachi, and do not think it needs to be encouraged,” said Hafiz Muhammad Tahir Mehmood Ashrafi, chair of the Pakistan Ulema Council, though he refused to elaborate.

The complexity arises due to the kinship bond. In Islam, when a baby feeds from a woman who is not the biological mother, any future marriage is forbidden between that baby and any of the woman’s own children.

Further exacerbating the concern is that in the 750 milk banks in nearly 70 countries, donors are anonymous and milk can be combined from several sources.

However, Raza said this would not have been an issue. “The original fatwa allowed us to mix a maximum of three to five mothers’ milk but we intend to keep it to one mother donating to one child at a time.”

Dr Azra Pechuho, health minister for Sindh province said: “When there is a properly developed digital identification system in place in Pakistan, keeping a record of which child got milk from which woman is not difficult.”

She said the state should not let this opportunity of “saving the lives of premature babies lapse because of this issue which is clearly resolvable”.

Ayan is not the only baby whose survival is at risk, said Dr Hassan Jabbar, who works in the 52-bed neonatal unit. The unit has, on average, between five and eight premature babies, who stay until they are strong enough to go home. A baby born at 26 weeks will stay for an average of six weeks, for instance.

“It’s the same story that keeps repeating and which is very distressing,” said Jabbar. “I just saw a baby weighing a kilogram whose mother died while giving birth; how do we feed him?”

Formula is no substitute he said. “I am totally against feeding babies with formula, it means putting them through even more complications. People say ventilators are important in an [intensive care unit]; I say mother’s milk is even more important. A vent costs 7.5m rupees [£4,000]; human milk is free.”

Leading paediatrician Dr DS Akram said breast milk protects babies in a way formula milk does not. “Premature babies have a very underdeveloped protection against bacteria in their intestines. If fed formula milk, [they] are at high risk of developing a severe gut infection called necrotising enterocolitis, which has a very high death rate.”

That is why, said Pechuho, “If we want our premature babies to survive we have to have human milk banks in all our obstetric and paediatric hospitals.”

Of the almost 15 million babies in the world born prematurely each year, nearly 1 million die due to complications.

According to the Pakistan Demographic and Health Survey 2018, the neonatal mortality rate in the country is 42 per 1,000 live births, one of the highest in the world.

“A premature baby cannot latch, cannot suckle and nor can he swallow, he has to be fed through a tube,” said Dr Syed Rehan Ali of the neonatal intensive care unit at SICHN, adding: “The milk bank was one way of reducing our dismal neonatal mortality rate.”

Last week, Pechuho told lawmakers in the Sindh assembly she will call upon the Council of Islamic Ideology to help make the initiative “Sharia-compliant”.

Now a month old, Ayan is on formula. “He’s gained weight and looks good,” said Munawwar. But cost is now a concern. “A tin of milk costs 2,600 rupees and it is consumed within six days,” he said. “I have three other kids and do not have a regular job,” he added.

Formula milk is not without danger, say doctors, in places where few adhere to safe practices of sterilising bottles and teats or are able to ensure the water used for mixing is clean. “Mothers from lower socioeconomic groups often reduce the proportion of the milk powder to the water for it to last longer, to save the cost,” said Akram.

Despite laws promoting breastfeeding, Akram said the relentless marketing of formula continues and has had an impact. It is now illegal for breastmilk substitute companies to approach healthcare facilities and for health professionals to promote their products.

Just 48% Pakistani mothers exclusively breastfeed their babies, lower than in Bangladesh (65%) and India (64%). In Sri Lanka 82% of women breastfeed their babies in the first six months.

The clerics did not respond to requests for comment.

Scientists have raised hopes for a cheap and simple test for autism after discovering consistent differences between the microbes found in the guts of autistic people and those without the condition.

The finding suggests that a routine stool sample test could help doctors identify autism early, meaning people would receive their diagnosis, and hopefully support, much faster than with the lengthy procedure used in clinics today.

“Usually it takes three to four years to make a confirmed diagnosis for suspected autism, with most children diagnosed at six years old,” Prof Qi Su at the Chinese University of Hong Kong said. “Our microbiome biomarker panel has a high performance in children under the age of four, which may help facilitate an early diagnosis.”

Rates of autism have soared in recent decades, largely because of greater awareness and a broadening of the criteria used to diagnose the condition. In the UK and many other western countries, about one in 100 people are now thought to be on the autism spectrum.

Studies in twins suggest that 60-90% of autism is down to genetics, but other factors contribute, such as older parents, birth complications and exposure to air pollution or particular pesticides in pregnancy. Signs of autism range from children not responding to their name and avoiding eye contact, to adults who find it difficult to understand what others are thinking and getting anxious if their daily routine is disrupted.

Scientists have long known that autistic people tend to have less varied bacteria living in their digestive system, but whether this is due to autism in some way, or actually contributes to the condition, is a matter for debate.

To delve deeper into the puzzle, Su and his colleagues analysed stool samples from 1,627 children aged one to 13, some of whom were autistic. They checked the samples to see which bacteria were present, and did the same for viruses, fungi and other microbes called archaea.

Writing in Nature Microbiology, the researchers describe how gut microbes differed markedly in children with and without autism. In all, 51 types of bacteria, 18 viruses, 14 archaea, seven fungi, and a dozen metabolic pathways, were altered in autistic children. Armed with machine learning, a form of artificial intelligence, the scientists were able to identify the autistic children with up to 82% accuracy, based on 31 microbes and biological functions in the digestive system.

The study revealed other changes too, with various metabolic pathways involved in energy and neurodevelopment apparently disrupted in the autistic children.

“While genetic factors play a substantial role in autism, the microbiome could act as a contributing factor by modulating immune responses, neurotransmitter production, and metabolic pathways,” Su said. “This does not necessarily imply causation, but suggests that the microbiome might influence the severity or expression of autism spectrum symptoms.”

If the researchers’ thinking is correct, and disruption to the microbiome does affect the severity of autism, it raises the prospect of personalised interventions that use diet or live bacteria known as probiotics to establish a more diverse microbiome in those diagnosed with the condition.

“Ultimately, this broad scope increases the potential to develop more effective, noninvasive diagnostic tools and therapeutic strategies for autism,” Su said. The team is now running a clinical trial to investigate whether stool samples can help to identify autistic children as young as one year old.

Dr Dominic Farsi at King’s College London said the results could have “great potential” in diagnostic practice, but added that more research was needed to confirm the findings. “Notwithstanding, these results could represent a big step towards enhancing diagnostic methods for autism spectrum disorder,” he said.

Dr Elizabeth Lund, an independent consultant in nutrition and gastrointestinal health, said: “The idea that analysis of stool samples may aid in diagnosis is very exciting, as currently there is a massive backlog in children and adults waiting to be assessed. The current process is very lengthy and there is a shortage of clinicians such as psychologists and psychiatrists trained to carry out a proper diagnosis.

“Clearly the study needs to be repeated by other groups and in other populations around the world, but the approach might offer a novel and more automated route to diagnosis in the longer term.”