Sara Sharif showed signs of starvation or the “rapid removal of food”, according to a pathologist who discovered an unusual indicator in her bone marrow, a jury was told.
A trial at the Old Bailey also heard how the 10-year-old schoolgirl had likely been strangled until a bone in her neck had broken, up to three months before she died last August.
It was one of many injuries the young girl suffered in an alleged “campaign of abuse”, which also included burns, broken bones and extensive bruising.
Sara’s father, Urfan Sharif, 42, is on trial for her murder, alongside her stepmother Beinash Batool, 30, and uncle, Faisal Malik, 29.
On Thursday, bone specialist Professor Anthony Freemont showed the court a number of X-ray images of her injuries, including fractures in her left hand and one in the u-shaped hyoid bone in her neck.
He told the court that according to his analysis and the stage of healing around the bone, the injury to her upper throat had likely occured between six to 12 weeks before her death.
He concluded that it had likely been caused “within the setting of neck compression” of which “the most common cause of these types of fractures is manual strangulation”.
When questioned about two fractures in her fingers, he said they were between 12 to 18 days old, with injuries such as these most “commonly associated with pulling the fingers apart”.
Of the injuries he examined, Professor Freemont said: “If you find fractures of different ages and different bones, there is a high likelihood they are non-accidental injuries.”
He added that the bone marrow had shown up with a “bluey tinge” which revealed itself to be gelatinous transformation of the bone marrow (GTBM). This can often be associated with starvation or the rapid removal of nutrition, although Professor Freemont could not say if this was a direct cause.
The previous day, jurors heard that another pathologist who carried out a post-mortem examination on Sara’s body gave the girl’s cause of death as “complications arising from multiple injuries and neglect”.
This included more than 70 injuries and a traumatic brain injury, as well as multiple bruises to her lungs.
No natural diseases or drugs had contributed to Sara’s death, and she had also suffered “probable human bite marks”, a burn from a domestic iron and scalding from hot water.
Traces of the schoolgirl’s blood were discovered on the kitchen floor, a vacuum cleaner and a cricket bat following a police search of the family home along with “homemade hoods” used to restrain her, the prosecution said.
Police found Sara’s body in a bunk bed in her home on 10 August, following a call from Sharif in Pakistan saying he “beat her up too much” for being “naughty”, the court heard.
It is alleged Sara had died two days before and the defendants had booked flights out of the country within hours of her death.
All three defendants, of Hammond Road in Woking, have denied murder and causing or allowing the death of a child between December 16 2022 and August 9 2023.
The trial continues.