They challenged Chief Coroner Mark Lucraft after he ruled an investigation into ringleader Khuram Butt before the outrage did not warrant criticism, even though he had been identified as a high-risk terror suspect. Survivors and relatives of those who died believe they were failed by the state and blasted the authorities for turning a deaf ear to warnings that the bridge was “crying out for protection”. Christine Delcros, horrifically injured in the attack which claimed the life of her boyfriend Xavier Thomas, condemned failures to install anti-vehicle barriers on London Bridge. 

But she praised a junior police officer who repeatedly tried to warn superiors that the bridge was open to attack following five deaths in a similar outrage at Westminster three months before. 

Ms Delcros spoke out as Judge Lucraft formally concluded at the Old Bailey that the eight victims who died on June 3, 2017, were “unlawfully killed”. 

He said it “was arguable” that shortcomings in the investigation into Butt breached Article 2 of the European Convention on Human Rights – the right to life. 

But he drew back from criticising MI5 or Scotland Yard’s counter-terrorism command. 

His conclusion was challenged by Helen Boniface of law firm Hogan Lovells, representing families of six of the victims. 

She said: “These inquests have been extremely challenging for the families who have noted the missed opportunities by MI5 to prevent the London Bridge extremists plotting an attack. 

“Despite the Coroner’s conclusion, families believe there were many lost investigative opportunities that could have identified the planning of this attack.” 

Driving in a hired Renault van, Butt, Rachid Redouane and Youssef Zaghba, killed two people on the bridge before crashing into a barrier close to the Barrow Boy and Banker pub. 

Canadian Chrissy Archibald, 30, lay dead on the bridge while French businessman Mr Thomas, 45, was knocked into the Thames. 

His body was found three days later. Armed with 12-inch knives taped to their wrists, Butt and his henchmen leapt out of the van and stabbed victims at random. 

By the end of the rampage Australian Sara Zelenak, 21, Briton James McMullan, 32, Frenchmen Alexandre Pigeard, 26, and Sebastien Belanger, 36, Australian Kirsty Boden, 28, and Spaniard Ignacio Echeverria, 39, had been killed. 

After 10 minutes Butt, 27, Redouane, 30, and Zaghba, 22, were shot dead by police. 

A total of 48 people were injured, many critically. 

Scotland Yard’s counter-terror command were stunned when they realised Butt had been under “active investigation”. 

A surveillance operation was being scaled back and his movements were not being monitored in the days before the attack. 

Met Police Deputy Assistant Commissioner Lucy D’Orsi said there was no intelligence suggesting bridges were under threat. 

But the inquest heard how City of London Police counter-terror expert Matt Hone repeatedly warned his superiors the bridge was wide open to attack. 

Gareth Patterson, representing the families of six victims, said the bridge with its broad, straight pavements with little kerb and no street furniture was “crying out for protection.” 

Ms Boniface added that lessons from the terror attacks in Nice, Berlin and on Westminster Bridge had not been learned. 

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London Ambulance Service chiefs admitted they took too long to send paramedics into the terrorist “hot zone” around Borough Market. 

A breakdown in communication between emergency services meant specialist medics stayed away from danger and the scene of carnage, a courtyard by Southwark Cathedral. 

Strict rules dictated no ambulance staff could step into the “hot zone” unless accompanied by armed police and firefighters, the inquest heard. 

No ambulance medic entered the courtyard until 1am – around three hours after the terrorists had been shot dead. The task of tending to the seriously wounded was left to young police officers with limited first aid training and little equipment. 

PC Mia Kerr was the first officer into the courtyard where the three killers had run amok. Armed with just a baton she stood guard as a couple tried to revive Mr Belanger. 

She said: “For a time I was the only officer down there. I was the person people were looking to for protection.” 

PC Kerr made repeated requests to police control for LAS support: “I was saying I needed paramedics but I was there half an hour and didn’t see any.” 

Police on the scene had no idea crews of 20 ambulances were massing in the street above. Nicholas Lesslar, the most senior LAS officer at the scene, repeatedly told the court he was unaware of casualties in the cathedral courtyard a short distance from where he was standing in the street above. 

He denied hearing a police officer yelling at him: “Are you a paramedic?” 

He said: “If I had heard a shout for help, I would have investigated.” 

Paul Woodrow, LAS director of operations, admitted that it took “too long” to send specialist teams into the courtyard. 

But he stressed that the “hot zone” – where terrorists were feared to be active – was set by police. 

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Unsung heroes of the attack included a nurse who looked into the eyes of one of the killers. 

Helen Kennett rushed to help Alexandre Pigeard after he was mortally wounded. 

“What’s wrong with you?” she demanded. The assassin replied: “No, what’s wrong with you?” and stabbed her in the neck. 

Roy Larner was dubbed the Lion of London Bridge after spotting Butt’s Arsenal shirt. 

As the knife-wielding killer strode towards him, football fan Mr Larner said: “**** you, I’m Millwall,” before he was stabbed. 

Journalist Geoff Ho tried to talk to Butt after he burst into the Black and Blue restaurant. 

“I thought if I rush him he may detonate and kill us all, if I talk to him maybe he’ll go away,” the Sunday Express City Editor said. 

“He was like an animal. He just wanted to kill people. 

“It was rage, the eyes were full of rage, just murderous rage.” 

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