The 8 year plight of foreign medics in Libya accused of intentionally infecting over 400 children with HIV and how the scientific community tried to help them.
On the 24th of July 2007, 5 Bulgarian nurses and 1 Palestinian doctor were released from Libya after having been jailed for more than 8 years [1]. They were accused by the Libyan government of intentionally infecting over 400 children by injecting them with HIV at the state-run Al-Fateh Children’s Hospital in Benghazi, Libya in 1998. The medics claimed their innocence in this matter but some confessed under the extreme pressure by being repeatedly tortured [2]. Through the years, their case was seen by several courts and the medics were subjected to numerous trials in which they were sentenced to death by fire squadron twice; first by the Benghazi Appeals court and then by the Libyan Supreme court. However, later on, the sentence was reduced to life imprisonment and they were released to Bulgaria by the High Judicial Council. This was after the families of the victims accepted compensation worth $1 million per child [3]. The Bulgarian President went much further by completely revoking their sentences and freeing them [1].
The medics were first convicted of conspiring with the CIA and the Mossad (the Israeli Intelligence Agency) to destabilize Libya by infecting these innocent children. This outlandish charge was later on dumbed down to: carrying out an experiment to test antiretroviral drugs for an unnamed foreign pharmaceutical company [4].These alterations in charges were probably to be more diplomatically correct in response to the opening up of the country to the world. At this time, trade sanctions were being lifted against the country because of it’s forgoing on the acquisition of weapons of mass destruction in 2003[5].
During the medics’ first trial, two well-known international HIV/AIDS experts, Luc Montagnier, the co-discoverer of the HIV and Vittorio Colizzi, a prominent Italian virologist, were called upon by the Libyan government to be international scientific consultants. They collaborated to conduct a scientific inquiry on the Benghazi outbreak and wrote a final report to the Libyan government. In it, they summarized a report by a WHO mission, carried out in Benghazi between December 1998-January 1999, stating that there was a lack of appropriate supplies and equipment to insure safety such as having sharp containers. They also observed that needles were shared without the use of suitable sterilization techniques. Montagnier and Colizzi wrote a statement summarizing the data collected. Some of the important points were that they concluded that the origin of the outbreak was most likely from one child being infected by injection of contaminated material by blood through a non-identifiable horizontal or vertical transmission (this is the index case). This child was already visiting the hospital before April 1997, which was earlier than the medics’ arrival. All of the samples sequenced from the other children showed that they belonged to a similar viral subtype to that of the index case and this was strong evidence that they had a common origin. They found that the HIV strain in these children belonged to the subtype A/G, a recombinant form of the virus frequently found in Central and Western Africa (the word ‘recombinant’ here has great significance and I will talk about this a bit later). There was also no proof that there was an intentional injection of HIV contaminated material and that epidemiological data and molecular analysis support this. More evidence that the outbreak was due to poor safety practices at the hospital was that two nurses were also infected with the same virus strain as the children. This incidence is extremely high compared to worldwide rates of healthcare staff acquiring HIV at work (There have only been 50 cases since HIV has been known to circulate) [6] .
Montagnier and Colizzi were called to testify for the medics in person. However, another report was ordered by the court from the Libyan National Expert Committee (LNEC). The report stated that the HIV outbreak was only observed in certain wards and not in the entire hospital and that all the wards should have been just as susceptible. This same point was also extrapolated to encompass other nearby hospitals in that none of them had had similar problems. The LNEC asserted that it was difficult to believe that the outbreak was a result of a ‘medical accident’ resulting from “misuse or lack of medical instruments” [7]
Regardless of the testimonials from the two international experts and the several scientific analyses made, the court refused to accept these as satisfactory evidence since it opposed the LNEC inferences; as a result, the court condemned the medics to death [4]. Montagnier later spoke out and said that he believed the verdict was in part based on a mistranslation from English to Arabic of the word ‘recombinant’, the Libyans understood it as meaning ‘genetically modified’ and therefore manipulated by humans [8].
More evidence to suggest that the medics were innocent was brought forward by Luc Perrin, a clinical virologist working at the Geneva University Hospital who treated many of the infected children. He found that many of them had several different subtypes of viral hepatitis. Perrin explained that “If a single source of contaminated blood had caused the HIV outbreak, all the children would be infected by the same hepatitis C subtype” “What we observed can [instead] be explained by the reuse of syringes or poor sterilization procedures” [9].
On the 28th of August 2006, the Libyan prosecutor condemned the medics again to a death sentence during the medics’ retrial at the Libyan Supreme Court. In response to this sentence Lawyers Without Borders, the medics’ attorneys, brought forth their case to the international community to call for an independent scientific assessment be conducted by international HIV/AIDS experts to shed light on how the children became infected. Up until this point, the case had not had much attention; international governments were more preoccupied with ‘more important’ issues surrounding the opening-up of the oil-rich Libyan country to the world’s markets [8].
Tulio de Oliveria et al. published a brief communications in Nature on the 14th of December 2006 to assist the medics in their struggle for justice. They were able to trace the transmission history of the outbreak by using molecular phylogenetic techniques to determine the origin of the HIV and HCV strains from the outbreak. They carried out two major analyses:
1. They compared the strains from the infected children to several reference sequences of strains that were closely related to those at Al-Fateh Hospital. Many of the children had the CRF02_AG strain which has a very close lineage to three West African reference sequences where the hospital is located. The virus sequences also had epidemiological link with sub-Saharan Africa owns which was anticipated since there are many migrants that come through Libya [10]. It showed that the strain was not ‘unusually divergent’, this statement clearly crossed out the possibility that the medics had inoculated the children with a ‘genetically modified’ strain that was suggested by the Libyan doctors[8].
2. They took advantage of the fact that virus sequences contain a ‘molecular clock’ about the date of origin and age of epidemics. This enabled them to estimate that the strains arose before March 1998, the arrival date of the medics[10]. Despite the evidence put forth by Tulio de Oliveria et al., the court pronounced the medics guilty on the 19th of December 2006 and that they be sentenced again to death by firing squad [3].
In actuality, the six medics were probably scapegoats for the Libyan government. It was much easier to lay the blame on foreigners than to accept that they were hugely at fault for not having provided funds for proper sanitary conditions at the hospital. More shocking is that some sources stated that Gaddafi (the Libyan President) deliberately withheld funds from the public health services of the city of Benghazi because the city was highly opposed to his rule. Other sources suggest that he used their case to install xenophobia to increase his popularity [4]. Furthermore, it was a good way of obtaining funds to pay the families for the extremely expensive healthcare incurred from the HIV infection (Europe set aside $461 million to the Benghazi International Fund to care for the children but was firm in stating that this money was not to pay for the medic’s release nor was it compensation to the families as that might have implied that the medics were in fact guilty) [11]. Two more demands were made in exchange for the medics’ release and were fulfilled: obtaining international recognition and to have the al-Megrahi case reviewed (he was convicted over the Lockerbie bombing that took place in 1988 in the UK and killed 270 people) [12]. Interestingly enough, Libya had actually demanded that each infected child receive $10 million, which was the same amount that Libya had to pay out to each family of the 270 people that were killed in the Lockerbie bombing [13].
This is a case where scientific evidence was stumped by political motives from both the Libyan’s and the international community’s side. I think it is a tragedy that these medics had to endure such atrocities and that they were unfortunate enough to become peons in a grand scale scandal.
To end this whole debacle, I would like to leave you with what Saif al-Islam (Gaddafi’s son) told the press on August 9th, 2007 after the release of the medics. During an interview with the international Arabic news channel, Al-Jazeera, he said that he had tried to attest that the medics were innocent but that the Libyan report contradicted his statement. What was most appalling though was that he admitted that the investigations that were carried out by his government were not of professional or scientific caliber but that they were used to blackmail the Europeans. He told Newsweek magazine “Yeah, it’s an immoral game, but they set the rules of the game, the Europeans, and now they are paying the price … Everyone tries to play with this card to advance his own interest back home”[14].
References
1. Bulgarian medics pardoned after arrival from Libya. (24 July 2007). The Independent. Retrieved: 3 February 2008. link.
2. Libya: Foreign Health Workers Describe Torture. (15 November 2005). Human Rights Watch. Retrieved: 8 February 2008. link.
3. Timeline: Bulgarian medics trial. (24 July 2007). BBC News. Retrieved: 2 Feb 2008. link.
4. Bad Blood; Libya. The Economist 2 November 2006:54.
5. Butler D. Europe condemns Libyan trial verdict. Nature 2007;445(7123):7.
6. Montagnier L, Colizzi V. Report on the Benghazi Outbreak. 2006.
7. Final report by the National Experts Committee regarding the scientific expert opinion required in Case 607/2003-Felonies/Benghazi. link
8. Butler D. Lawyers call for science to clear AIDS nurses in Libya. Nature 2006;443(7109):254.
9. ‘A shocking lack of evidence’. Nature 2006;443(7114):888-9.
10. de Oliveira T, Pybus OG, Rambaut A, Salemi M, Cassol S, Ciccozzi M, Rezza G, Gattinara GC, D’Arrigo R, Amicosante M and others. Molecular epidemiology: HIV-1 and HCV sequences from Libyan outbreak. Nature 2006;444(7121):836-7.
11. Compensation paid in Libya HIV case. (17 July 2007). Aljazeera. Retrieved: 6 February 2008. link.
12. Home at last, after eight years of hell in a foreign prison. (25 July 2007). Times Online. Retrieved: 7 February 2008. link.
13. Brunwasser M. Workers Arrive in Bulgaria After Being Freed. (24 July 2007). The New York Times. Retrieved: 7 February 2008. link.
14. Libya acknowledges medics’ torture. (9 August 2007). Aljazeera. Retrieved: 8 February 2008. link.
