Effect Measure

Nature’s senior correspondent Declan Butler is one of the print science journalists who understands the internet and its power. He is now part of an effort to see if it can save six lives.

Lawyers defending six medical workers who risk execution by firing squad in Libya have called for the international scientific community to support a bid to prove the medics’ innocence. The six are charged with deliberately infecting more than 400 children with HIV at the al-Fateh Hospital in Benghazi in 1998, so far causing the deaths of at least 40 of them. On 28 August, when the prosecution was scheduled to close its case, the Libyan prosecutor called for the five Bulgarian nurses and a Palestinian doctor to be sentenced to death. Attorneys from Lawyers Without Borders, who are handling the defence of the six, have responded by calling for the international community to request that the court order an independent scientific assessment, by international AIDS experts, of how the children became infected. The medics were condemned to death in May 2004, but the Supreme Court quashed their convictions last December, following international protests that the first trial had been unfair. It ordered a retrial, which has run intermittently since 11 May at the Criminal Court of Benghazi, based in Tripoli. A verdict is expected within weeks.(Declan Butler, writing in the News section of Nature)

The story goes on to note that so far the scientific community has shown little interest in the case. I expect it’s because most of us haven’t heard about it. Now, thanks to Declan’s story in Nature, accompanied by a very strongly worded Editorial, we have. The question now is whether the scientific blogosphere can help stop this imminent tragedy. Luc Monagnier’s HIV group at the Institut Pasteur in Paris and Vittoria Colizzi of Rome’s Tor Vergata university did a genetic analysis of the viruses from the children and concluded many were infected before — perhaps long before — the medics arrived in 1998:

The researchers carried out a genetic analysis of viruses from the infected children, and concluded that many of them were infected long before the medics set foot in Libya in March 1998. Many of the children were also infected with hepatitis B and C, suggesting that the infections were spread by poor hospital hygiene. The infections were caused by subtypes of A/G HIV-1 — a recombinant strain common in central and west Africa, known to be highly infectious. But the court threw out the report, arguing that an investigation by Libyan doctors had reached the opposite conclusion. Montagnier believes the judgement was based at least partly on mistranslation from English to Arabic of the term ‘recombinant’ — instead of referring to natural recombination of wild viruses, as intended, it was interpreted to mean genetically modified, implying human manipulation.

There are other ugly aspects to the case, which without the Montagnier/Colizzi evidence was based partially on confessions extracted under torture. The outraged parents are pressing for an explanation and foreign medics are more convenient than bad medical care. A last ditch attempt now is being made to restore some scientific content to the trial by demanding an independent scientific panel examine the evidence. If the Tripoli court returns a guilty verdict — now considered likely that the scientific evidence has been excluded — the only hope would be an appeal to the Libyan Supreme Court to convene the panel.

This would seem to be a place for diplomatic pressure but the United States and the European Union have looked the other way:

At present, the case has been sidelined by broader geopolitical interests in the opening of oil-rich Libya to international relations, says Antoine Alexiev, another defence lawyer on the case. The United States decided in May to reestablish diplomatic relations with Libya. And Muammar Gaddafi, the Libyan leader, has been given red-carpet treatment at the European Union’s headquarters in Brussels — without mention of the medics’ situation.

That statement is from Declan’s news article. The Nature Editorial is even stronger and blunter:

Despite the medics’ plight, the United States agreed in May to reestablish diplomatic relations with Libya, 18 years after the bombing of an airliner over Lockerbie in Scotland that killed 270 civilians. Many observers had expected a resolution of the medics’ case to be part of the deal. And the European Union has given Muammar Gaddafi, the Libyan leader, red-carpet treatment at the European Commission in Brussels.

International diplomacy, dealing as it does with geopolitical and economic realpolitik, by necessity often involves turning a blind eye. But its lack of progress in response to the medics’ case in Libya is an affront to the basic democratic principles that the United States and the European Union espouse. Diplomacy has lamentably failed to deliver.


Finding a scapegoat is easier than having to admit that the infection of the children was an accidental tragedy. But the most likely diplomatic compromise — that the medics will be condemned to death, with this being commuted to a life sentence — is unacceptable. They are innocent, and the law and science can prove it, if they get the belated opportunity. That is why scientists should lend their full support to the call by Lawyers without Borders — a volunteer organization that last year helped win the freedom of Amina Lawal, who had been sentenced to death in Nigeria for having a child outside marriage — that Libya’s courts should order a fully independent, international scientific assessment of how the children were contaminated. (Editorial, Nature)

Declan has more on his blog, along with links to some documents, including the Montagnier/Colizzi Report. We need to mobilize the worldwide scientific community and have them communicate immediately with their own Foreign Offices/State Departments and also the Libyan embassies in their countries to demand this independent scientific investigation.

These six are international aid workers. Nurses and a doctor. They are our colleagues, our brothers and sisters in a global war on disease and suffering, now sacrificial lambs in a game of internal Libyan politics. Nature is leading the way on the print side. No one knows what the scientific blogosphere can do. Let’s find out.


  1. #1 Susan in Iowa
    September 21, 2006

    Firedoglake blog has a post on this story, as well as a tool to get the word out to the media. Go to the URL below, then to the third line from the bottom of the main post (not comments), click on the word “spotlight.”


  2. #2 G in INdiana
    September 21, 2006
  3. #3 revere
    September 21, 2006

    Susan: I am very grateful to FDL for the great post and there is also now a terrific front pager on dKos and The Next Hurrah, thanks to my wiki partner DemFromCt. Last count seven posts by my Science Blog sibs. Declan is collecting the links over at Connotea (http://www.connotea.org/user/Declan/tag/tripoli%20six?num=25) and some of us are trying to devise a concerete “To Do” strategy. Randy (MRK) passed on a very useful email address which we are pursuing as well.

    Thanks to everyone who is helping so far. We will try to have concrete things to do shortly.

  4. #4 Rod
    September 21, 2006

    Action could be convincing other aid workers to withdraw from Libya until this is satisfactorily resolved.

  5. #5 Maia
    September 21, 2006

    The idea of aid workers withdrawing from Libya might work if we could trust the Libyan government to care that aid workers were withdrawing. Would this type of negotiation work with Libya?
    Certainly it may save the lives of aid workers, but would Libyan lives be lost in the process?

  6. #6 Michal R. Pijak
    December 22, 2006

    I was shocked by the recent decision of the court in Tripoli confirming the death sentences in the retrial of five Bulgarian nurses and one Palestinian doctor, detained since 1999 and convicted on charges of intentionally infecting more than 400 Libyan patients, primarily children, with the human immunodeficiency virus (HIV) at the hospital in Benghazi in 1998. Because of this issue I would like to discuss about some knowledge referring to the risks for transmission of this infection within this country, which I obtained during my duties at the Department of Internal Medicine at the Faculty Hospital in Misurata during the years 1987-1990.

    During the first months of my duties at the aforementioned health facility, I had a chance to see some patients which had the typical signs of advanced AIDS. I was very surprised at the attitudes of the chief of the department, by the way, a very experienced and educated doctor from the Sudan, who did not want to accept, that, he would have to deal with this kind of disease which supposedly was not present in Libya. Besides that, he threatened me, that, if in the future I discussed this situation, I could have some serious problems.

    This attitude I automatically explained to myself as part of the propaganda of the government�s regime which do not wish to admit the presence of AIDS because of cultural, social, and religious norms that discourage alcohol, drugs abuse and promiscuity. Although the Islamic moral code forbids such indulgences, in reality, they are widely practiced among men. This may explain that some governments do not wish to admit the presence of AIDS which reflects the type of society there.

    It is important to note, that Libyan citizens had, at this time, the possibility to freely travel to the surrounding countries like Tunisia but also to Western Europe, where the presence of this disease was wide spread. Another imoportant factor that may impact the spread of HIV include a large population of migrant workers, mainly from sub-Saharan Africa, the worst affected region in the word where more than 1/2 of all HIV-infected people live. Moreover, the city of Benhazi, where the university is located, was known for the presence of a significant number of sex workers from Egypt.

    Another important mode of infection might be through poor hospital hygiene, which independent investigations of the hospital showed was prevalent. Especially I want to emphasize that spreading of the infection could have been a result of insufficient examination of blood donors at the transfusion station. The data from blood donations is particularly interesting because all blood collected in Lybia�s public-health facilities is voluntarily donated by family members of patients. It is possible that this method of gaining blood donors could have led to disparagement of precautions for exclusion infected donors.

    Consistent with this assumption is the UNAIDS/WHO Working Group on global HIV/AIDS and STI Surveillance data showing,the HIV seroprevalence in 1998 among blood donors was 0,22%. Furthermore, at the and of 2002, HIV infection had been reported among 5,160 Libyans and 1,159 foreigners. More then 80% of all reported HIV infections have occurred in the past four years, suggesting a sharp increase in incidence has recently occurred. An estimated 90% of recent adult infections are the result of injection drug use.

    Without these previous experiences, I would not have any reasonable doubts about charges against these health care workers. The paradox is that not long ago, I was pointing to a quote from The Green Book of the Libyan leader Muammar al-Qaddafi condemning the toleration of boxing in sports. Of interest, the quote states that �The more the people become civilized and sophisticated, the more they are able to ward off both the performance and the encouragement of these practices.� I would therefore expect that the Libyan government, instead of scapegoating foreign medical professionals of doubtful accusations from bio-terrorism, rationally and humanly admit the overwhelming evidence that underestimation of preventive practices in the country, led to the spread of HIV-1 and other blood born infections.
    UNAIDS/WHO epidemiological fact sheets on HIV/AIDS and Sexually Transmitted. Diseases. Libyan Arab Jamahiriya http://www.who.int/GlobalAtlas/predefinedReports/EFS2004/EFS_PDFs/EFS2004_LY.pdf

    Pijak MR. One more reader responds to “boxing should be banned in civilized countries–round 4”. MedGenMed. 2005 Oct 14;7(4):12.

    al-Qadhafi M. Sport, horsemanship and shows. In: The Green Book: Part Three: The Social Basis of The Third Universal Theory. Tripoli, Libya: Public Establishment for Publishing, Advertising and Distribution. Available at: http://www.geocities.com/Athens/8744/readgb.htm Accessed October 3, 2005.

  7. #7 revere
    December 22, 2006

    Dr. Pijak: Thank you for your detailed and dismaying account of your experiences. Yes, it is very distressing to see what has happened with respect to these health care workers and the likely continued infection of patients as a result of poor hygiene in Libya and many other places in Africa as a result of poor hygienic practices.

  8. #8 john edgard
    September 14, 2007

    thank you, your write. good job. 😉

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    November 10, 2007

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