The Tripoli 6 and new scientific evidence: urgent call to the science blogosphere

We are asking the scienceblogging community once again to rally on behalf of our colleagues on trial for their lives in Libya. They have been accused of infecting over 400 children with HIV (see previous posts, here, here, here, here, here and here). When last we made an appeal (here) the response was extraordinary and spread quickly to the blogosphere on both the left and right sides of the political spectrum. The campaign to save the six health workers began with a strongly worded editorial in Nature and spread via the science blogosphere to the wider science and human rights organizations and from there to the New York Times, Washington Post, the Economist and beyond (see Declan Butler's account and here for the links to over 400 blog and other posts). Nature has kept up the pressure and all this resulted in an appeal by 114 Nobel Laureates, just as the trial ended without hearing the scientific evidence. The verdict and sentencing if guilty (as expected) will be on December 19. [More below the fold]

Why Nature and the scienceblogosphere for a human rights case, even a high profile one? Because this is also a science story, or, more properly, a story where science that could have exonerated the defendants has been ignored, resulting in a trial which was neither fair nor impartial. That science has now appeared (.pdf), appropriately, in Nature, the world's most prestigious scientific journal. An exhaustive analysis of the HIV and Hepatitis C sequences from virus isolated from 44 of the children finds the "strains were already circulating and prevalent in the [al-Fateh Hospital] and its environs before the arrival in March 1998" of the defendants. Thirty seven of the children had some eepidemiological data available and it shows that all had undergone invasive procedures, either as inpatients or outpatients. This supports the overwhelming evidence that the most likely mode of infection was through poor hospital hygiene, which independent investigations of the hospital showed was prevalent.

The Supplementary Materials provided with the Nature publication provide a good summary of events related to the science:

In March 1998 six foreign medics (five Bulgarian nurses and a doctor from Palestine) joined the medical staff at AFH [Al Fateh Hospital]. One year later, these individuals were accused of purposefully infecting more than 400 children with HIV-13. They have been detained in prison ever since. In April 2003, at the court's request, two international HIV/AIDS scientists, Luc Montagnier and Vittorio Colizzi conducted a scientific inquiry into the Benghazi outbrea. In their report, they conclude that given the high rate of Hepatitis B and C infection amongst the children, the contamination was more likely to be caused by pre-existing poor hygiene practices rather than a single introduction. Furthermore, their report suggests that the HIV-1 and HCV epidemics were present in the hospital prior to the arrival of the Bulgarian medical staff. However, the Libyan court found this report to be imprecise and lacking in evidence and therefore decided not to consider its findings in the trial. In December 2003, a second scientific report produced by Libyan researchers was written for the court. This document has been central to the prosecutor's case against the six medics.

In May 2004, the foreign medical staff were condemned to death. However, in response to international appeal, the Libyan Supreme Court ordered a retrial on the 25th of December 2005. The new trial began in Tripoli on the 11th of May 2006, and on the 29th of August, the prosecution again called for the medics to be sentenced to death. The last session of the trial began on the 4th of November 2006 and the final verdict is due to be given on the 19th of December. Attorneys from Lawyers without Borders, who are representing the defendants, have appealed to international AIDS experts to conduct an independent scientific inquiry into the history of the Benghazi HIV-1 outbreak. This paper is a response to their appeal. (Benghazi Study Group, Supplementary Materials to Oliviero et al., Nature online, 6 December 2006; cites omitted)

It is difficult in a short blog post to describe the unusual thoroughness and care of the phylogenetic analysis done by this dedicated cadre of international investigators from Oxford and Rome. Declan Butler has a good news piece in Nature, along with a sampling of opinion by independent international experts on the methods and interpretation and pointing out that this kind of evidence has been used for 15 years in forensic analysis of HIV infections.

We hope that once again the science blogosphere will help marshal the potent support of the internet community in this signal human rights case. We remind all bloggers, letter writers and anyone else that expresses an opinion about this to heed the prudent advice of those long involved in these kinds of cases: the objective is to help our colleagues held prisoner and under threat of a death sentence. It is not to relieve our own feelings. Governments don't usually respond to abuse or condemnation. Nor is it necessary. The science speaks loudly enough on behalf of these medical workers, but it must be heard by the Libyan authorities who have it in their power to assure a fair and just outcome to this this tragedy.

We know your earlier efforts made a difference. We can only hope it will help affect the anticipated judgment of the Libyan court.