HIV trial in Libya

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The HIV trial in the country of Libya concerns the trials and appeals of six foreign medical workers charged with conspiring to deliberately inject 426 children with HIV in 1998, causing an epidemic at El-Fath Children's Hospital in Benghazi.^[1] The main defendants are a Palestinian medical intern and five Bulgarian nurses (often termed "medics").^[2] They are presently under sentence of death, pending a final appeal.

The epidemic at El-Fath and the subsequent trials are highly politicized and controversial. The epidemic is the largest documented outbreak of HIV within a hospital in history, and it was the first time AIDS became a public issue in Libya. The Libyan public was enraged and the foreign medical workers were arrested. Libyan leader Muammar Gaddafi initially blamed the CIA or Mossad for plotting to carry out a deadly experiment on the Libyan children. He has also repeatedly linked the case to the Lockerbie trial.

Libya requested and received help from two of the world's foremost HIV experts, including one of the original discoverers of AIDS, to conduct a scientific investigation into the causes of the epidemic. These experts submitted a report, which traced the origins of the outbreak, and blamed poor sanitary practices in the hospital wards for the cross-contamination of the patients. The "Final Report" of Prof. Luc Montagnier and Prof. Vittorio Colizzi was introduced into evidence, at a criminal trial of the medics in Benghazi, and the scientists testified on behalf of the defense. The prosecution introduced a report by Libyan scientists with contrary conclusions. The medics were found guilty in May 2004 and sentenced to death by firing squad.

Reaction was swift, with a number of appeals from scientific and human rights organizations, and various official condemnations of the verdict along with diplomatic initiatives. The sentence was appealed and overturned, however, the retrial resulted in another death sentence in December 2006. With each new result the case has drawn more international attention. It remains unresolved.

Contents 1 the El-Fath epidemic in Libya 1.1 Background to the Accusations 1.2 The Trials 1.3 First Trial 1.4 Second Trial 1.5 Retrial 1.6 Development of Media Coverage 1.7 Libyan HIV Victims 1.8 Science 1.9 Torture 1.10 The Lockerbie Linkage 1.11 The Diplomatic Front 2 Defendants 2.1 Ashraf Ahmad Djum’a al-Hadjudj 2.2 Kristiyana Vulcheva 2.3 Nasya Nenova 2.4 Valya Chervenyashka 2.5 Snezhana Dimitrova 2.6 Valentina Siropulo 2.7 Zdravko Georgiev 2.8 Defense team 3 International: Official Positions 3.1 African Union 3.2 Arab League 3.3 Bulgaria 3.4 Council of Europe 3.5 EU 3.6 Libya 3.7 Russia 3.8 United States 4 NGO: Official Positions 4.1 Amnesty International 4.2 International Council of Nurses 4.3 Physicians for Human Rights 4.4 World Medical Association 4.5 Newspapers and Journals Editorial Positions 4.6 Bulgarian Advocacy Campaigns 5 Breaking news 6 Scientific studies and reports 6.1 The WHO Report of Dr. P.N. Shrestha (1999) 6.2 Final Report of Prof. Luc Montagnier and Prof. Vittorio Colizzi 6.3 Final report by the Libyan National Experts Committee 6.4 Genetic analysis study published in Nature 6.5 Refutation in The Libyan Journal of Medicine 6.6 Professor Luc Montagnier letter to Muammar Gaddafi 6.7 Bagasra et al response letter to the previous scientific reports 7 Timelines 8 See also 9 References 10 External links

[edit] the El-Fath epidemic in Libya

[edit] Background to the Accusations

The El-Fath epidemic is the largest documented incident of hospital-induced (nosocomial) HIV in history.^[3] The crisis first came to light in November 1998 when Libyan "La" magazine (issue 78) published an expose about AIDS at the hospital.^[4][5] In December the Association of Libyan Writers reported over 60 cases of AIDS so far that year in Libya. "La" interviewed Sulaiman al-Ghemari, Libyan Minister for Health, who told them that most of the cases are children. Parents believed their children were infected through blood transfusion in Benghazi's main children hospital.^[6] "La" magazine was shut down but it was eventually revealed that over 400 children had been infected. Libya requested and received an emergency WHO team which was sent in December and stayed through January of 1999. The WHO team issued a classified report on the situation.

In February 1999 the Bulgarian embassy announced that 23 Bulgarian specialists had been "kidnapped". A week later they were informed by Libyan authorities that “precautionary measures” had been taken against Bulgarian doctors and nurses working at the Benghazi Children’s Hospital. Most of the nurses were recruited by Bulgarian state-owned company Expomed to work at the Libyan hospital, where pay was considerably higher than they could receive at home, beginning work in February of 1998. On March 7, 1999 six members of the group subjected to "precautionary measures" were formally arrested on a warrant in connection with the case of infecting children in Benghazi with HIV.^[7] The group consists of Ashraf al-Hajuj, a Palestinian intern, and Bulgarian nurses Kristiyana Valtcheva, Nasya Nenova, Valentina Siropulo, Valya Chervenyashka, and Snezhana Dimitrova. They are later to become widely known as "the Benghazi Six" a term first promulgated by advocacy groups, and adopted by some of the western popular press.^[8]

[edit] The Trials

The first case against the medics was brought in the (now disbanded) People’s Court (Mahkamat al-Sha`b), a special court for crimes against the state. The trial began on February 7, 2000. The charges were: intentionally "murdering with a lethal substance (Article 371 of the Penal Code), randomly killing with the aim of attacking the security of the State (Article 202), and causing an epidemic through spreading harmful virus, leading to the death of persons (Article 305)." In addition, Bulgarians were accused of acting contrary to Libyan customs and traditions, by engaging in non-marital sexual relations and drinking alcohol in public places, distilling alcohol, and illegally transacting in foreign currency.^[7][9]

In April of 2001 Libyan leader Muammar Gaddafi made a speech at the African summit on HIV/AIDS. He told the conference that the world AIDS epidemic started when "CIA laboratories lost control over the virus which they were testing on black Haitian prisoners"^[10] He called the HIV crisis in Benghazi "an odious crime" and questioned who was behind it."Some said it was the CIA Others said it was the Mossad Israeli intelligence. They carried out an experiment on these children." He went on to say that the trial would be "an international trial, like the Lockerbie trial."^[11][12]

[edit] First Trial

The defendants all plead not guilty. The Prosecution submitted the Defendants confessions in evidence. The defendants all repudiated their confessions. They gave interviews and testified at trial that they were forced to confess by the use of torture.^[13][14][15] This led to charges being filed against 10 Libyan security personnel, some of whom later claimed they had also been tortured, tortured to confess that they had tortured the medics.^[7] The guards were eventually acquitted in subsequent trials.

The prosecution described a plot to disrupt Libya by foreign secret services."To those services, child killing is nothing new. In this way they want to prevent Libya from playing an important role in the Arab World and to disturb calm in the country. The killing of the children by that virus is a means by which those secret services achieve their ends" In calling for the death penalty the prosecutor said:"These people have no moral human feelings once they have killed those children. They have sold themselves to the devil, even though the Jamahiriya has given them the right to work and live without let or hindrance." He described the epidemic as a "national catastrophe."^[16]

The defendants denied being part of a conspiracy. Nenova, Chervenyashka, Siropoulo and Dimitrova testified that they did not know Vulcheva until 24 hours after what they called their "kidnapping" from Benghazi, and, according to Nenova, only after their blindfolds were taken off. Vulcheva denied knowing John the Englishman or Adel the Egyptian. They all denied that they had been paid "large sums of money" to infect the children. Nenova and Vulcheva admitted that they had seen Ashraf at the Benghazi Children's Hospital, but testified that they did not communicate with him and did not perform any tasks assigned by him.^[16]

The defense lawyers argued that physical evidence on all the charges was lacking, including, the blood bottles alleged to contain contaminated plasma, the device alleged to have been used by Kristiyana Vulcheva to distil alcohol, the syringes which were alleged to have been used to commit the crime, and the photos alleged to show sexual relationships between the defendants. Lawyer Sheitanov, argued that the medics had neither the time nor the conditions to carry out a conspiracy to commit the crime, since Nenova, Siropoulo and Chervenyashka started work at the children's hospital on February 17, 1998, Dimitrova on August 10, and Ashraf on August 1, 1998.^[16]

A year after the trial began, the People's Court ruled that it did not have jurisdiction in the matter."The People's Court has the jurisdiction to pronounce itself on state security-related cases and believes itself incompetent on this matter, the spreading of the HIV virus which caused the death of more than one person is a fact, but the claims that the defendants were conspiring against the Libyan state are dubious and controversial"^[16] The case was then bound over to ordinary criminal court. The People's Court was disbanded in 2005.^[17]

[edit] Second Trial

The second trial took place in the Benghazi Appeals Court, beginning July 8, 2003. The judges were from Derma, a town neighboring Benghazi. Judges from Tripoli and Benghazi refused to take on the case due to the high level of public sentiment in those cities. Tight security measures were in place. Police officers with submachine guns guarded the venue as relatives of the children gathered in front.

The prosecutor stated that the case documents do not reflect the real number of children. The real number of children is 429. A report by prominent AIDS experts Luc Montagnier and Vittorio Colizzi was admitted in evidence.

Prof. Luc Montagnier and Prof. Vittorio Colizzito were called to testify in person on behalf of the medics. Professor Montagnier, the co-discoverer of AIDS, testified that the virus in the 393 children studied is a rare type found mostly in West African but also through out the continent. Montagnier told the court that the outbreak was probably started by an infected child admitted for treatment at the hospital. He said that injection was not the only possible means of infection, any other manipulation involving penetration of the skin, or even multiple use of the same oxygen mask, could have transmitted the virus. Montagnier was certain that the epidemic at the hospital started about a year before the Bulgarian nurses were hired. He said he was familiar with the case before his first visit to Libya in 1999 because he was in the process of studying the cases of hundreds of HIV-positive children from Al-Fath that were being examined or treated in hospitals in Switzerland, France and Italy. At the time he was working on these cases, some of the children did not yet have the symptoms because the incubation period of the virus is about 10 years.

Under cross examination Montagnier stated that it is possible to preserve the virus and then reactivate it if it has been held in plasma. It could be kept active between two and several days, depending on how it is stored. He testified that he was not aware of the existence of the technical capacity in Libya for monitoring this kind of storage, either during the epidemic or currently. Montagnier testified that during his first visit, the health authorities in Libya and the management of the Benghazi hospital showed serious concern over the infection, and that at the time they had no idea of the cause of the epidemic's spread.

When questioned by the Bulgarian defense; he affirmed that the infection could have started outside the hospital ward where the Bulgarians were working.

The Court ordered a new expert study of the case record. It received the report from the Libyan panel in December. Contrary to the findings of Prof. Luc Montagnier and Prof. Vittorio Colizzi, this panel concluded that there was no evidence that an in-hospital infection led to the AIDS outbreak at the Benghazi hospital that affected 426 children. The Libyan doctors concluded that the mass infections were more likely due to deliberate actions.

Two of the Libyan experts were brought in to testify for the prosecution, Awad Abudjadja of the Libyan national committee on AIDS and Busha Allo, head of the infectious diseases ward of the Al Jamahiriya hospital in Tripoli. They testified that the virus load in the blood of the infected children was too high, an indication that the infection was intentional.

Another Libyan virologist Salim Al-Agiri was summoned by the defense. He told the court that the infection at the Benghazi children's hospital was due to lack of prevention and poor control.

The prosecutors called for the death penalty based on Nassya Nenova's confession. Nenova admitted in writing to injecting children with contaminated products that she had gotten from the Palestinian Ashraf al-Hajuj. According to the confession. she was unaware that they contained HIV, and believed she was testing a new drug. Nenova withdrew her confession before the Libyan People's Court in 2001 and told that court they were extracted under duress. Libyan law disregards confessions extracted with violence.

The prosecutors claimed that Kristiana Vulcheva, acted as the mastermind. They introduced transcripts of her bank accounts and said she performed money transfers, paying the other defendants. The prosecutors, averred that Vulcheva had a luxurious lifestyle and that she speaks Arabic, citing that, as a further proof of her guilt.

One piece of material evidence which they said called for the death penalty are 5 containers of plasma protein found to contain 4 varieties of the HIV virus according to a report by Awad Abudadjadja, a coordinator of the Libyan national committee on AIDS.

On May 6, 2004 the Criminal Court in Benghazi sentenced to death by firing squad; Ashraf al-Hajuj, Kristiyana Valtcheva, Nasya Nenova, Valentina Siropulo, Valya Chervenyashka, and Snezhana Dimitrova, finding them guilty for the intentional infection of 426 Libyan children with AIDS. Dr Zdravko Georgiev was found guilty of illegal transactions in foreign currency and sentenced to four years in prison and a fine of 600 dinars. He was ordered released for time served.

In public after the conviction Colizzi called the scientific evidence used against them "so irrational it's unbelievable" and said the verdict read "like a bad spy film".^[18]

[edit] Retrial

The convictions were appealed to the Libyan Supreme Court which heard the case beginning on March 29, 2005. The defense urged the court to revoke the death sentences and remand the case to the lower courts for retrial. Under Libyan law, the court could not accept any new evidence, although the defense team argued that there was wrongly interpreted evidence during the court sessions so far. There were a number of delays and postponements.^[19] Eventually the Supreme Court revoked the death sentences and ordered a new trial.^[20]

Bulgarian president Georgi Parvanov said the court ruling "confirmed our hope that justice in this case will prevail." President Parvanov added: "The unfair death sentences were reversed. …We hope that the swiftness and the effectiveness demonstrated by the Libyan court in the past days will help solve the case as soon as possible." US State Department spokesman, Justin Higgins, described the decision as a "positive development since it removes the risk of the death penalty being carried out. As we have made clear before, we believe a way should be found to allow the medics to return to their home". The Council of Europe welcomed the decision and said it hoped the new trial will "comply with the internationally recognised standards of fairness and due process".

On December 19, 2006, the court pronounced its verdict in the retrial, all six were guilty, and again sentenced to death by firing squad.^[21] Following the verdict the court published a 100 page document on the website of 'Libya Today' newspaper explaining its decision.

The text of the judgment and ruling issued on 19 / 12 / 2006 the Court of Appeal in Benghazi (in Arabic)

According to the document:

The mothers of the HIV-infected children do not carry the virus

Unnaturally high levels of HIV in the children's blood testified to the fact that the infection was intentional.

The infection only spread in the specific hospital rooms that the five nurses were serving.

The research by the World Health Organization showed that the HIV infected children also had Hepatitis C, which was proof that the infection was intentional and malicious.(1)

The court also said that it is not willing to accept the fact that the five were tortured, because another court has already waived this accusation, and found therefore that the defendants all confessed in full consciousness and without being subject of any violence or torture.^[22]

The case has been appealed again to the Supreme Court, the final hearing before possible review by the Libyan government's Supreme Judicial Council.^[23]

1. (Co-infection with Hepatitis was emphisized as indicating poor hygiene and reuse of syringes by the WHO study authors themselves, as well as all of the other non-Libyan studies used by the defense, the opposition conclusion to this analysis by the court)

[edit] Development of Media Coverage

In Libya, "La" magazine (issue 78) published it's expose about AIDS at the hospital, but was shut down. Initial Bulgarian coverage focused on a scandal in the wake of the arrests when the Bulgarian news journal "24 hours" of February 24th published an investigation of money laundering at Expomed entitled "How we lost USD 5,048, 292 in Lybia".^[24] The trial received almost no public attention outside Libya and Bulgaria until an account by Eric Favereau was published in the French paper Libération on June 2 2000 entitled "Libye : Six Bulgares accusés d’être à l’origine de 393 cas de sida Assassins d’enfants ou boucs émissaires de la Libye ? " (Libya: six Bulgarians accused of causing 392 Aids cases - Child killers or Libya's Scapegoats?).^[25][26][27] Libya had requested help and France Italy and Switzerland had received some of the sick children, 80 were sent to France in May 1999. The Swiss paper Neue Zuercher Zeitung followed with the article “Bulgarians as Scapegoats” July 11, 2000 and the Washington Times picked up the story.^[25] In April 2001 the trial gained brief attention after Muammar Gaddafi gave his speech at the African summit on HIV/AIDS implicating the CIA.^[11][12] The US sponsored Radio Free Europe countered with a conspiracy theory of its own, employing former KGB agent Viktor Suvorov. Suvorov claimed that the theory about CIA creating HIV and letting it loose in Africa had been invented by the KGB and was still promoted by Russian secret services, who were controlling Libya.^[25] This theory was widely published throughout the Balkans in Serbian and Greek newspaper articles. On July 2, 2001 the Washington Post ran a story by Peter Finn, interviewing Prof. Luc Perrin (who had been involved with the children sent to France. Perrin dismissed the allegations of a deliberate infection, and WHO spokesperson Melinda Henry told the Post that members of WHO missions in Libya in 1998 and 1999 felt that further study was necessary, but they “were not invited back.” The case continued to receive minor attention until the conclusion of the second trial and the imposition of the death penalty on May 6, 2004, which provoked a major reaction, and worldwide television coverage.

[edit] Libyan HIV Victims

Well over 400 children were infected with Aids at the El-Fath Children's Hospital. Some are receiving treatment in Europe. The death toll so far has surpassed 50. Parents and relatives of the children protested, and demanded the death penalties to be carried out.^[28]Libyan prime minister, Shukri Ghanem, insisted that the outcome of the trial was entirely a juridical matter. In a statement broadcast on the Qatar TV channel Al Jazeera, Mr Ghanem said that all efforts should now be focused on the infected children, "who are subject to a death sentence each day."^[29] The families of the infected children also demand compensation for the actions taken by the convicted medics: figures of up to $10 million per family have been mentioned .^[30]

Scans of November 1998 issue 78 of banned 'La' magazine

AIDS in our children

Who is responsible?

Cover p.1 p.2 p.3 p.4 p.5 p.6 p.7 p.8 p.9 p.10 p.11 p.12 p.13 p.14 p.15 p.16

The text of the judgment and ruling issued on 19 / 12 / 2006 the Court of Appeal in Benghazi (in Arabic) with list of victims

Musical photo-montage of the Libyan children with AIDS and images of families protesting at the trial in real media format. (in Arabic) montage

[edit] Science

There have been several reports done on the HIV outbreak. The most important of these, the Final Report of Prof. Luc Montagnier and Prof. Vittorio Colizzi was commissioned by the Libyan Jamahiriya, and arranged through UNESCO. Montagnier and Colizzi had access to all the files of the infected subjects available at the Hospital as well as samples from European hospitals that had taken some of the sick children, as well as the samples at Al-Fatih.

Their report concluded that the infection at the hospital resulted from poor hygiene and reuse of syringes, and that the infections began before the arrival of the nurses and doctor in 1998. Through hospital records, and the DNA sequences of the virus, they traced it to patient n.356 who was admitted 28 times between 1994–97 in Ward B, ISO and Ward A, and theorized that this patient was the probable source of the infection. The first cross-contamination occurred during that patient's 1997 admission. The report concludes that the admission records of a total of 21 of the children "definitively prove that the HIV infection in the Al-Fateh Hospital was already active in 1997" and that "Ward B was already heavy contaminated in November 1997."^[31] The epidemic snowballed in 1998 to well over 400 children.

Montagnier and Colizzi both testified in person at the trial of record for the defense, and the report was submitted in evidence.^[32] The prosecution advanced a contrary report drawn up by a Libyan expert panel. The scientific community became politically embroiled in events when the criminal court in Bengahzi rejected Montagnier-Colizzi in favor of the conclusions of the Libyan experts. After the conviction, Colizzi said the scientific evidence being used against them "is so irrational it's unbelievable" and the verdict read "like a bad spy film"^[18] Professor Colizzi submitted a letter to the President of the Court of Justice, stating that:

"Our impression is that the goal of this home-made report was to displace the responsibilities of nosocomial HIV infection from the health care people of the Hospital to the foreign Bulgarian personnel. Of course the latter personnel may share part of this responsibility, in using or accepting incorrect practices, but it does not mean a deliberate action of poisoning children."

"Scientists have done their job, the game is in the hands of politicians and journalists." Dr. Vittorio Colizzi^[18]

114 Nobel Laureates in the sciences co-signed an open letter to Libyan leader Muammar Gaddafi calling for a fair trial.^[33]

[edit] Torture

All of the defendant say they have been tortured. Ashraf Ahmad Djum’a al-Hadjudj has reportedly lost an eye and one of his hands has been paralyzed. Snezhana Dimitrova declared that her hands were tied behind her back and she was hung from a door dislocating her shoulders, and that she was told to "confess or you will die here". Nasya Nenova testified that "We were alone there with those men who did everything they wanted to do". In May, 2005 Human Rights Watch interviewed them in Jadida prison

Ashraf Ahmad Jum'a, the Palestinian Intern, told Human Rights Watch “We had barbaric, sadistic torture for a crime we didn’t do,” “They used electric shocks, drugs, beatings, police dogs, sleep prevention.” The interview conducted in the presence of a prison guard. “The confession was like multiple choice, and when I gave a wrong answer they shocked me,”^[14]

Valentina Siropulo, told Human Rights Watch “I confessed during torture with electricity. They put small wires on my toes and on my thumbs. Sometimes they put one on my thumb and another on either my tongue, neck or ear,” “They had two kinds of machines, one with a crank and one with buttons.”

Kristiana Valceva, said interrogators used a small machine with cables and a handle that produced electricity. “During the shocks and torture they asked me where the AIDS came from and what is your role,” She said that Libyan interrogators subjected her to electric shocks on her breasts and genitals. “My confession was all in Arabic without translation,” ... “We were ready to sign anything just to stop the torture.”^[14][15]

Lawyers for the accused medical personnel have asked for 5 million Libyan dinars (approx. 3.7M USD/3.1M EUR) as compensation. Much of the evidence is based on medical reports prepared by authorities from Bulgaria relating to marks and scars on the defendants. All of the accused Libyans deny the charges, and none of them were jailed. After several procedural delays, their trial began in late May 2005. On June 7, 2005, the ten defendants were acquitted.^[34]

On January 30th 2007 defense lawyer Osman Bizanti said the prisoners may now face new charges of slandering Libyan police. Nikolay Kokinov, Sofia's City Prosecutor, confirmed that an official Bulgarian procedure against 11 Libyan officers suspected of torturing the nurses would be launched.^[35][36]

[edit] The Lockerbie Linkage

Since his speech in April of 2001 at the African summit on HIV/AIDS Libyan leader Muammar Gaddafi has repeatedly linked the HIV trial to the Lockerbie trial. In that speech he told the summit that the world AIDS epidemic started when "CIA laboratories lost control over the virus which they were testing on black Haitian prisoners"^[10] He called the HIV crisis in Benghazi "an odious crime" and questioned who was behind it."Some said it was the CIA Others said it was the Mossad Israeli intelligence. They carried out an experiment on these children." He went on to say that the trial would be "an international trial, like the Lockerbie trial."^[11][12]

Gaddafi has proposed releasing the six medics, if the convicted Pan Am Flight 103 bomber Megrahi, serving a life sentence in a Scottish jail, were to be released; and US$2.7 billion compensation were paid to Libya for the care of the HIV-infected patients (the exact sum offered by Libya in compensation for the 270 lives lost in the 1988 Lockerbie bombing).

Bulgaria refused to pay any compensation on the grounds that it would be admitting the guilt of the medics. On June 7 2005 , the European Union engaged in negotiations to provide assistance to Libya, but not directly linked to the case of the six medics. On August 18, 2005, Libya recommended that Bulgaria should negotiate on the amount of the payment. The next week, the Council of Europe Parliamentary Assembly (PACE) delegate visited Libya and saw the medics. On August 31, Bulgarian Foreign Minister Ivaylo Kalfin stated that Bulgaria would send humanitarian aid while not acknowledging the guilt of the medics.^[37]

On September 8, 2005 it was announced that Libya had prepared a list of 40 items (non-monetary) that should be sent as aid and that Bulgaria could supply 24 of them.

Dec 2006 In a speech in Tripoli on the occasion of the Muslim festival of Al Adha and the Christian New Year season, Gaddafi again compared the case to the trial of Libyan Abdel Basset Ali al-Megrahi, who was found guilty in 2001 of the Pan Am plane bombing over Scotland. "Organisations such as the Arab League, the non-aligned movement and the Islamic Conference said al-Megrahi was a political prisoner and international observers said elements of foreign intelligence were present at the trial, Nobody asked for his release"

He went on to say that "The important thing is why the medical team injected the children with AIDS. Who ordered you -- was it Libyan intelligence, American intelligence, Israeli intelligence or Bulgarian intelligence? This is what we have to find out,"

The Bulgarian Foreign Minister responded that "The linkage of the case against the Bulgarian nurses in Libya to the Lockerbie Case is completely unacceptable and groundless," ^[38][39]

The families of the infected children demanded compensation for the actions of the convicted medics: figures $10 million per family have been mentioned — the same level of compensation offered by Libya for the families of the 270 victims of the Lockerbie disaster.^[30]

[edit] The Diplomatic Front

There have been a number of diplomatic efforts to resolve the crisis.

One of Gaddafi's sons Saif al-Islam al-Qaddafi, has admitted at least some Libyan responsibility. On December 24, 2005, it was announced that Libya, Bulgaria, the EU, and the US had agreed on a fund which may help to resolve the matter.

The Bulgarian independent daily newspaper Novinar published a set of 12 cartoons mocking Gaddafi, Libyan justice and the Bulgarian government's 'quiet diplomacy' vis-à-vis the HIV trial. Publication of the cartoons caused outrage in Tripoli and the Libyan ambassador in Sofia delivered a protest note to the Bulgarian Foreign Ministry. In response, the Bulgarian Deputy Foreign Minister, Feim Chaushev, and President Parvanov apologized and distanced themselves from Novinar's cartoons.

The six medics were again sentenced to death.^[40] EU Justice Commissioner Franco Frattini quickly expressed his shock at the verdict and called for the decision to be reviewed, as was done by the Bulgarian government and international organizations, including Amnesty International, the World Medical Association and the International Council of Nurses.^[41]

The Libyan foreign ministry said international response to the convictions and death sentences was disrespectful to the Libyan people. The foreign ministry also said (as reported by the Washington Post) "The political stance expressed by the Bulgarian government, the EU countries and others is a clear bias to[wards] certain values that are likely to trigger wars, conflicts and cause enmity between religions and civilizations."

[edit] Defendants

Initially, 23 foreign medical personnel were arrested, mostly Bulgarian, but 17 were released and have returned to Bulgaria. Additionally, 11 Libyan nationals were arrested and charged with the alleged crimes. Doctor Zdravko Georgiev a Bulgarian went to Libya to see his wife (Valtcheva); subsequently he was detained and tried on the charge of illegally transacting in foreign currency. The following Libyans were also arrested and tried on non capitol offences: Atia at-Tahir Ali al-Juma (director of the Benghazi hospital), Halifa Milyad Mohammed al-Sherif (head of hospital ward), Abdul Azis Husein Mohammed Shembesh (head of hospital ward), Abdul Menam Ahmed Mohammed al-Sherif (head of hospital ward), Idris Maatuk Mohammed al-Amari, Salim Ibrahim Suleyman Abe Garara, Mansur al-Mansur Saleh al-Mauhub, Nureddin Abdulhamid Halil Dagman, and Saad Musa Suleyman al-Amruni (assistant secretary of the health care sector in Benghazi).

[edit] Ashraf Ahmad Djum’a al-Hadjudj

Photos: [3] [4]

Palestine: Information with Provenance (PIWP database)^[42]

Defendant number one in the case. In the prosecution view he is the man in the deadly criminal ring of female nurses dedicated to a plot involving agents of foreign governments, large sums of money, illegal, adulterous sex, and illegal alcohol. He has been convicted of murdering 426 Libyan children in the service of that plot, with the intention of destabilizing the country. He is an intern who started working at the hospital two months before news of the epidemic broke out. His family said they fled Libya because they have been portrayed by the Libyan media as "killers of innocent children" and are now in the Netherlands. Ashraf's cousin in Palestine As'ad El-Hajouj told the Turkish Daily News, that Ashraf had lost an eye and that one of his hands had been paralyzed because of torture he endured while in prison.^[43][44]

Petition الحملة الدولية لاعادة فتح ملف الجريمة النكراء بحق أطفال بنغازي وتقديم الجناة للقضاء العاد

[edit] Kristiyana Vulcheva

Photo: [5] [6]

Kristiyana Vulcheva was not recruited by Expomed. She is the wife of Doctor Zdravko Georgiev who was charged along with the others but ultimately was found not guilty of all charges after having been once convicted of currency violations. Purported by the prosecution to be the ringleader of the plot, it was claimed she spoke Arabic, and had a luxurious lifestyle. The other four testified that they had never seen Vulcheva before their blindfolds were taken off after their so-called "kidnapping" by Libyan security, when they were first brought to the police compound in February 1999. Vulcheva was also the only one charged and convicted of illegally distilling alcohol. The defense pointed out that no device used to do this was produced at trial. She admitted in court to having seen Ashraf at the Benghazi Children's Hospital, Unlike Ashraf, she never confessed to having sexual relations with him, which is required to convict for the crime of adultery under Libyan law. She retracted her confession that vials were given to her by a British citizen which were used to infect the children,dening knowing any such person as 'John the Englishman' or having been paid "large sums of money" to infect the children^[45] After the re-imposition of the death sentence in 2006 it was announced that Vulcheva would be seeking to have Vladimir Sheitanov represent her again. Plamen Yalnuzov had replaced him as representative for the Bulgarians in 2002. After the verdict her mother made a public plea "We are sending our plea to the British government and the victims of Lockerbie. We are well aware the issue is painful to all, but in the name of the most humane of the professions we ask them to be merciful and let Megrahi go.", referring to Abdel Basset Ali al-Megrahi who is serving a life sentence in Scotland for the Lockerbie bombing.^[46] Gaddafi has repeatedly compared the two cases. After the 2006 verdict he said "Organisations like the Arab League, the non-aligned movement and the Islamic Conference said al-Megrahi was a political prisoner and international observers said elements of foreign intelligence were present at the trial... Nobody asked for his release."^[38]

[edit] Nasya Nenova

Photos: [7] [8] (with Kristiyana Vulcheva)

Nasya Nenova attempted suicide. She testified that she confessed and attempted suicide because she was afraid she would be tortured again. She was interrogated alongside Ashraf and told the court they were beaten and that there was no interpreter. She did not confess to having illegal sexual relations with him. She along with Vulcheva are the only nurses who admitted knowing Ashraf by sight beforehand but said she had never spoken with him. She denied having attempted suicide out of guilt for what she had done. In court she stated that "I am not guilty on any of the counts. My conscience is clear" and "We had protection from no-one, we had no doctor. We were alone there with those men who did everything they wanted to do". She said she attempted to retract her confession on July 17, 1999 but that a Colonel Juma came and threatened to renew the torture if she persisted.

She is seeking reappoint Vladimir Sheitanov as a replacement for defense attorneys Yalnyzov and Byzanti after the 2006 death sentence.^[47]

[edit] Valya Chervenyashka

Photos: [9] [10] daughter's 2005 NPR interview [11]

She is from Byala Slatina. She was recruited by Expomed company. Her husband Emil Uzunov in a 2003 interview with Bulgarian National Radio (BNR) said that the defence lawyer Bizanti was one of the torturers who beat the six medics during the initial interrogations.Chervenyashka had to correct the story. "I suppose my husband was too nervous and overreacted," she said.^[48]

Her daughter Antoaneta Uzunova has commented on the case."It's been terrible. ... The charges were absurd then, they remain absurd now," she said in 2005. "When I heard them being described as CIA agents ... I knew what would happen," said Uzunova, 28. "Then we found out our loved ones had been tortured in a most cruel way. It's a nightmare."^[49] At another time she said "Nurses from little towns in Bulgaria acting as agents of Mossad?" "It all sounds funny and absurd until you realize your mother could die for it."^[50]

She is seeking reappoint Vladimir Sheitanov as a replacement for defense attorneys Yalnyzov and Byzanti after the 2006 death sentence.^[47]

[edit] Snezhana Dimitrova

Photos: [12] [13]

Dimitrova did not arrive at the hospital until August 10, 1998. She was recruited by Expomed. She is the only one of the condemned to have been picked up for questioning in the roundup of medical workers on December 14, 1999. She was held for two days then, and rearrested with the others on February 10, 1999.

In a handwritten 2003 declaration to the Bulgarian Foreign Ministry, Snezhana Dimitrova, described torture that had included electric shocks and beatings.

"They tied my hands behind my back," she wrote. "Then they hung me from a door. It feels like they are stretching you from all sides. My torso was twisted and my shoulders were dislocated from their joints from time to time. The pain cannot be described. The translator was shouting, 'Confess or you will die here."'^[50]

[edit] Valentina Siropulo

Photos: [14] [15]

“I confessed during torture with electricity. They put small wires on my toes and on my thumbs. Sometimes they put one on my thumb and another on my tongue, neck or ear. It had a hand crank to make it go. They had two kinds of machines, one with a crank and one with buttons.”^[51]

[edit] Zdravko Georgiev

Doctor Zdravko Georgiev the husband of Kristiana Vulcheva, came to Libya after his wife was arrested. He was charged along with the others but ultimately was found not guilty of all charges after having been once convicted of currency violations. Photo: [16]

[edit] Defense team

Libyan defense attorney Othman al-Bizanti

Dr Danail Beshkov, Libyan medical consultant to the defense

Vladimir Sheitanov

Plamen Yalnuzov

[edit] International: Official Positions

The trials have been condemned by The European Union, individual EU member nations, the United States and Russia. Medical experts and scientists also disputed the convictions, as well as numerous human rights organizations.

[edit] African Union

The African Union The African Union (AU) Commission has expressed concern at what it calls "politicization" of the case.

According to the Angola Press the AU Commission said all of Africa was monitoring the case with great interest, and that attempts to politicize the matter must stop forthwith.

The AU also expressed solidarity with the families of the victims and its desire. It said people should not aggravate the tragic case, where 56 of the infected children have already succumbed to AIDS.^[52]

[edit] Arab League

According to Sofia News Agency, The Arab League "asked all countries not to politicize the issue, as the accused have still one more chance for appealing their sentence. The League also underlined the need to be compassionate to the HIV-infected Libyan children in order to curb the consequences of this painful human catastrophe".

[edit] Bulgaria

[edit] Council of Europe

Recommendation 1726 (2005)

Serious human rights violations in Libya – Inhuman treatment of Bulgarian medical staff

The Committee of Ministers and the Parliamentary Assembly severely condemned this verdict which is contrary to the fundamental values they uphold....The Parliamentary Assembly...categorically condemns the barbaric way in which they were treated in the first few months after their arrest and the torture and ill-treatment to which they were subjected. It considers that there is no proof of their guilt and that they are being used as scapegoats for a dilapidated Libyan health system. The Assembly is shocked by the attitude of hatred towards them in public opinion, fueled by certain sections of the Libyan leadership and media which have stirred up public resentment against these five women and this man....

• ....distinguished specialists, testifying under oath at their trial, exonerated the nurses and the doctor, showing clearly that the infection had broken out in 1997 ....
• ...one of the nurses never even worked at the Benghazi paediatric hospital....
• ...the experts proved that the storage conditions of the bottles of blood plasma used as prosecution evidence were such as to preclude any conclusive biological analysis...
• ....numerous breaches of Libyan law (torture, procedural irregularities...
• The Assembly thus concludes that the Bulgarian nurses and the Palestinian doctor should be regarded as completely innocent
• ...The Libyan authorities, sheltering behind the independence of their country’s judicial system ...consider that the payment by Bulgaria of compensation to the families and the provision of free care for the contaminated children in European hospitals are essential prerequisites for any progress on the nurses’ case...Bulgarian authorities have categorically rejected all of Libya’s financial demands, refusing to buy the release of the nurses by paying compensation to the Libyan victims, as this would be tantamount to recognising the nurses’ guilt and, beyond that, the Bulgarian State’s responsibility.^[53]

[edit] EU

European Commission Statement of then-EU President Romano Prodi:

"We have learnt this morning that the Court in Benghazi today sentenced the Bulgarian medics to death. It appears that the Court said that they deliberately infected hundreds of Libyan children with the HIV virus. The EU has repeatedly expressed its serious concerns regarding the conduct of the investigations, the treatment of the defendants and the delays in bringing the case to a conclusion. It has also expressed concerns about the lack of compelling evidence of the guilt of the defendants. The case was made to the Libyans authorities again this morning when the Troika met with them in Dublin at the Euromed Ministerial meeting. The Commission is extremely preoccupied and deeply disappointed by the court's ruling. While it had expressed its solidarity with the Libyan families and in continues to do so, it also reiterates its total opposition to the death penalty. The Commission remains in contact with the Libyan authorities and will urge them to reconsider the case to reach a satisfactory situation at soonest."

External Relations Commissioner Christopher Patten:

"This verdict casts a shadow over the EU's recently improving relations with Libya. The EU was shocked and deeply concerned by the sentences, hopes that the Libyan authorities would promptly consider this concern and the fully justified stand of the Bulgarian Government."

[edit] Libya

[edit] Russia

Ministry of Foreign Affairs - Alexander Yakovenko, Spokesman:

"According to our information, the Bulgarian medics' lawyers intend to appeal this decision in the Supreme Court of Libya. For our part, we hope that an additional trial in Tripoli, in which all the facts and the opinions of people involved in this case will be comprehensively examined and taken into account, will help to save the Bulgarian medics' lives."^[54]

Foreign Minister - Sergei Lavrov:

"The verdict is contentious, and we share the opinion of those who consider it callous, and believe that it does not take into account certain factors presented at the court hearings,""We are appealing to the Libyan leadership to show mercy, and to solve the problem through satisfactory means, obviously through court procedures,"^[55]

[edit] United States

State Department - Richard Boucher, Spokesman:

"We find the verdict that was pronounced in the court to be unacceptable, and we've raised this case frequently with senior Libyan officials.An official from the U.S. Interests Section in Tripoli attended the trial proceedings in Benghazi . We recognize the great human tragedy that occurred in Benghazi and our deepest sympathy is extended to the families of 400 children who were infected with the HIV/AIDS virus; the death of over 40 children is also a devastating toll.But in this particular case, we note the defendants have the right to appeal their verdict, and we urge the Government of Libya to take steps to resolve this case quickly."

Assistant Secretary for Near Eastern Affairs - C. David Welch:

We remain very concerned about the case of Bulgarian and Palestinian medics imprisoned in Libya on charges of intentionally infecting children with HIV/AIDS. We have great sympathy for these children and their families and we are supporting efforts to help them. That said, our position on the medics has not changed. We believe a way should be found to allow them to return home and we are committed to helping resolve that issue as soon as possible.

Secretary of State Condoleezza Rice:

On May 15, 2006: I am pleased to announce that the United States is restoring full diplomatic relations with Libya. We will soon open an embassy in Tripoli. In addition, the United States intends to remove Libya from the list of designated state sponsors of terrorism. Libya will also be omitted from the annual certification of countries not cooperating fully with United States anti-terrorism efforts.

On December 20, 2006: Stated that the United States was "very disappointed with the outcome" of the trial and that the medical workers should be "allowed to go home at the earliest possible date."

[edit] NGO: Official Positions

[edit] Amnesty International

In a statement on May 6, 2004, a statement from Amnesty International was released: "We are shocked by the imposition of these death sentences and call for the Libyan authorities to immediately quash them. Amnesty International reminds the Libyan authorities that evidence extracted under torture must not be invoked as evidence in any legal proceedings."^[56]
In another statement after sentencing, on December 19, 2006: "We deplore these sentences and urge the Libyan authorities to declare immediately that they will never be carried out. The death penalty is the ultimate cruel, inhuman and degrading punishment, and in this case it has been imposed after a grossly unfair trial."

[edit] International Council of Nurses

ICN President Christine Hancock:

“The sentence is unjust, unwarranted and unacceptable.” “We implore the Libyan government to rectify this dreadful situation as quickly as possible. The health workers are being unfairly held responsible for a tragedy which has caused outrage in Libya.”^[57]

[edit] Physicians for Human Rights

An Open Letter to Gaddafi from leading virologists and doctors regarding the death sentences of 6 health professionals was released by Physicians for Human Rights. The signators included Vittorio Colizzi and AIDS discoverers Luc Montagnier and Robert C. Gallo.

The letter called on Gaddafi to "commute the death sentences," and to "review the procedures that have led to the targeting of these foreign health workers." The letter stated that "the widespread infections were not deliberately perpetrated by those accused" and that "we believe the Benghazi Criminal Court has disregarded the explicit findings... and has proceeded without a firm grasp of the scientific realities." explaining that "when HIV infections are transmitted through medical procedures or other unsterile conditions at health facilities, the transmissions do not occur because of ill will on the part of health care workers. Rather, the causes tend to be systemic to the health facility or health systems, including improper training of health workers, a high workload, insufficient supplies, or inadequate infection prevention and control procedures."

The Open Letter concluded: "Due to the scientific evidence and to credible reports that the health workers were tortured into false confessions, we believe that the defendants have suffered extreme prejudice in their case. Accordingly, we urge the Libyan authorities to dismiss the case, and to release to their home countries the imprisoned medical personnel who were invited to your country to help treat the sick. We urge you to ensure that these health professionals are protected, given any medical attention they may need, and are not further abused while still in detention."^[58]

[edit] World Medical Association

Dr. Yoram Blachar, chairman of the WMA Council, said after a meeting of the WMA:

"I appeal to the Libyan authorities to quash this sentence. It is completely unjustified."^[59]

[edit] Newspapers and Journals Editorial Positions

Libya's cruel trial of medical staff Nov 2nd 2006 The Economist^{[citation needed]}

A Travesty in Libya A new cure for AIDS: Shoot foreigners. Sunday, October 29, 2006 Page B06 Washington Post^{[citation needed]}

Nightmare in Benghazi 31-10-2006 Guardian^{[citation needed]}

Libyas travesty Nature 21 September 2006^[60]

PAY UP OR DIE Bulgarian Nurses Face Death Penalty in Libya November 09, 2005 Der Spiegel^{[citation needed]}

A farce in Libya deserves the full glare of international scrutiny June 02, 2005 The Daily Star (Lebanon)^{[citation needed]}

Quiet diplomacy is not enough 14 August 2004 British Journal of Medicine^{[citation needed]}

[edit] Bulgarian Advocacy Campaigns

After the December 12^th 2006 death sentences were announced, three Bulgarian media organized a campaign called Не сте сами (Ne ste sami - You are not alone in Bulgarian) to support the medics. Its stated aim is to cause a huge reaction around the world and to keep public attention on the problem until it is solved. It included issuing thousands of ribbons carrying the You are not alone logo in Bulgarian and English, as well as bumper stickers. Every supporter is encouraged to produce flags, badges, etc to support the campaign. Some of the Bulgarian airlines showed their support to the campaign by putting the ribbon on their planes.^[61] Currently the campaign has the support of all Bulgarian communities, including all religious institutions, media and institutions. On February 9^th 2007 (8 years after the initial arrest) more than 25000 people rallied to show their support in Bulgaria's capital. Thousands more were supporting in concurrent rallies in many Bulgarian cities and towns.^[62] On March 8th, 2007, Tottenham Hotspur star and Bulgarian international striker Dimitar Berbatov wore a "Не сте сами/You are not alone" armband in Spurs' UEFA Cup match against SC Braga.

These are a few of the organizations that support the campaign:

• "Не сте сами/You are not alone" campaign site - www.nestesami.bg
• petition to free the medical staff
• Petition in Support of The Bulgarian Nurses, Latest News on the trial
• Form to send an email to Libyan officials
• The HIV Libya case resource page, October 2006 by Declan Butler, senior reporter at Nature
• Physicians for Human Rights campaign - lobbying on behalf of the accused
• - Novinar Daily's initiative to nominate the nurses for the 2007 European Parliament elections

[edit] Breaking news

• 27 January 2007: The Bulgarian 24 Часа newspaper (24 Hours) reports that Gaddafi's elder son, Saif al-Gaddafi expressed hope that the death sentence could be halted and that "a satisfactory solution could be found."^[63]

• 15 February 2007: Dimitar Ignatov, a 25-year-old US citizen with Bulgarian origins, who launched two phony web pages for gathering money in support of Libya-jailed nurses, was arrested in a joint raid conducted by policemen from both countries. The money obtained in the scam had gone to his personal account in a Chicago bank.^[64]

• 17 February 2007: Lawyer Hari Haralampiev said for Darik News that this was the last possible deadline for appealing the sentence before the Supreme Cassation Court of Libya. The court will have to hold the first hearing on the appeal within two months. The court's decision on the case will be the final one in the trial. The Supreme Court may reconfirm or waive the sentences. If they decide to nod the death sentences, then the case would go to the Supreme Court Council where the sentences can be either confirmed, changed or abolished.^[65]

• 21 February 2007: Another "entrepreneur" decides to cash in on the "You Are Not Alone" campaign. A One-Lev shop in the southwestern town of Blagoevgrad has started selling the ribbons, despite the fact that they have only been distributed for free since the beginning of the campaign.^[66]

• 25 February 2007: The nurses and medic plead innocent to charges of slandering Libyan officers Djuma Misheri and Madjit Shol at a hearing in Criminal Court in Tripoli. The nurses once again pointed them out as their torturers on 1999. They told the court, "Everything that the two officers claim is a contemptible lie," and showed the scars the men left on their bodies. The prosecutor demanded the maximum three-year prison sentence for the nurses in the slander case.^[67]

• 28 February 2007: Libyan authorities appeal the court's decision to acquit Bulgarian doctor Zdravko Georgiev.^[68]

• 9 March 2007: Libyan Secretary of the Foreign Affairs Committee Suleiman Shahoumi is quoted by Bulgarian media as saying last week in Libya's General People's Congress that the medics will not be executed even if the court upholds their sentence.^[69]

• 15 March 2007: Bulgarian international footballer, Dimitar Berbatov, who plays for Tottenham Hotspur Football Club is supporting the "You Are Not Alone" campaign during Spurs' soccer matches by wearing an armband.^[70]

• 16 March 2007: Bulgarian journalist Georgi Gotev proposes that Bulgarian parties and voters cooperate to elect the nurses as Bulgaria's representatives the European parliament in order to pressure both Libya and the European Union.^[69]

[edit] Scientific studies and reports

[edit] The WHO Report of Dr. P.N. Shrestha (1999)

The WHO report (1999) describes the visit performed by the WHO team (Dr. P.N. Shrestha, Dr. A. Eleftherious and Dr. V. Giacomet) to Tripoli, Sirte and Benghazi the 28 December 1998 – 11 January 1999 while the Bulgarians were still on staff.

The report is apparently classified.

"This Report strongly suggests that the nosocomial HIV infections at the Al-Fateh Hospital were caused by multiple sources of infections. Moreover, the WHO team notes the lack of required supplies and equipment such as sharp container, sterilizer, incinerator, protective gloves, etc. […] The WHO has noted several similarities with previously documented outbreaks in children such as in Elista, USSR in 1988 and in Romania in 1990. In particular, the practice of using in dwelling intravenous catheters for injections in hospitalized children and sharing the same syringes without appropriate sterilization, would appear to be possible causes of the outbreak in Benghazi."

Montagnier/Colizzi 2003

[edit] Final Report of Prof. Luc Montagnier and Prof. Vittorio Colizzi

Prof. Luc Montagnier (Paris, France) and Prof. Vittorio Colizzi (Rome, Italy) were appointed as international scientific consultants by the Secretary of the Libyan Arab Jamahiriya.

All foreign European Hospitals that received the Libyan children were asked for full co-operation.

UNESCO organised a site visit for Prof. Colizzi at the Benghazi Hospital to have access to all the files regarding the infected subjects available at the Hospital and to collect all the available samples.

Sequencing of HIV and HCV isolates from other samples for children and adults infected at the Benghazi Hospital and from an other local communities were done at independent laboratories. He was to make a scientific report about all data collected and suitable considerations on the infection.

Working from Libyan documents at Al-Fatih hospital, the patients were divided into seven categories based on case history. They reported that the first infection (patient zero) "was already present in the Benghazi Hospital in April 1997" and found that "According to the Al-Fateh digital List in the year 1997, at least 7 children were already found infected. At least 14 children admitted and discharged from the Hospital in January and February 1998 (before the Bulgarian staff under Court took in the positions in the Hospital) were found to be seropositive when the analyses were performed in late 1998."

Reviewing the history of the seven patients who were infected by 1997 and were not admitted after 1998 (Category A, n. 308, 312, 340, 350, 356, 373, 385) the team theorized that patient n. 356 who was admitted 28 times between 1994–97 in Ward B, ISO and Ward A was the probable source of the infection. The comment is that Ward B was already heavy contaminated in November 1997

Three Children (Category B) were admitted and found seropositive after the 9 February 1999, date of departure of the Bulgarian staff. N. 349, 376, 384. The comment is that the infection was still active also in the absence of the Bulgarian staff.

"For infections included in Categories A-B-C-D there is no evidence that correlate infections with the presence of the Bulgarian staff in the Al-Fateh Hospital (arrival: first week of March 1998; till 9 February 1999): total numbers are 32. But, more importantly, Categories A and C definitively prove that the HIV infection in the Al-Fateh Hospital was already active in 1997. The identity in the cluster of DNA sequences of the HIV in this nosocomial infections, published by the Swiss and by the Italian groups, strongly indicate that the infection already existed in 1997 and was capable to spread in 1998 and in 1999."

The report concluded with the statement:

• "The HIV nosocomial infection of children which occurred at the Al-Fateh Hospital of Benghazi in 1997-1998-99 has presumably originated from the use of injection material contaminated by blood of one child infected through unidentified horizontal or vertical (more probably) transmission. This putative zero patient was present already in the Hospital before April 1997 (first sequenced child), and the horizontal contamination of some children was already operating in 1997, in the year 1998, and still in March 1999 (last sequenced child). All samples sequenced from these children (1997-1998-1999) belong to a similar viral subtype, strongly indicating a common origin.

• "The HIV strain responsible for this nosocomial infection belongs to the subtype A/G, a recombinant form of virus frequent in Central and West Africa. The transmissibility virulence and pathogenicity of this particular A/G HIV-1 strain has been shown to be very high, as also suggested by the putative retroinfection from some infected children to mothers by breast feeding.

• "The high number of cases (around 450), and the period of time of the nosocomial infection (over three years) can be explained by both the high specific infectivity of this strain and certain incorrect practices used by the medical and nursing staff at that time. This assumption is also supported by the high percentage of infected nurses in the Al-Fateh Hospital (two nurses as opposed to a total number of 50 cases of infection in hospital workers all over the world after 20 years of HIV circulation). Alteration of the specific guidelines established to avoid nosocomial infections (not only for HIV but also for HCV), a large introduction of invasive procedures, the shortage of disposable materials leading to the re-use of injection material, are all possible reasons which may explain this massive nosocomial infection.

• "No evidence has been found for a deliberated injection of HIV contaminated material (bioterrorism). Epidemiological stratification, according to admission time, of the data on seropositivity and results of molecular analysis are strongly against this possibility."

The prosecution refuted the Montagnier/Colizzi report with a response from a five member panel of Libyan experts. This panel discounted the Montagnier/Colizzi because there was no proof that there had ever been syringe reuse in any Libyan hospitals. Additionally the Libyan panel stated that indwelling intravenous catheters were not available in the hospital and were never imported. The Libyan panel also concluded that if such improper practices were being had been taking place, there would have been widespread and serious outbreaks over a much longer period of time in contrast to the current instance.

Colizzi then submitted a letter to the President of the Court of Justice contending that he and Montagnier found the report of prosecutors panel unscientific and pointed out that all the data that the Libyans referred to as "inconsistent" was actually the data collected from the Libyan side. He concluded by stating that

"Our impression is that the goal of this home-made report was to displace the responsibilities of nosocomial HIV infection from the health care people of the Hospital to the foreign Bulgarian personnel. Of course the latter personnel may share part of this responsibility, in using or accepting incorrect practices, but it does not mean a deliberate action of poisoning children."

^[71]

[edit] Final report by the Libyan National Experts Committee

The brief report (Dated December 28, 2003) is given in Nature Journal, 443-7114.

Summary of results:

• The HIV outbreak at the Al-Fateh Children Hospital was only observed in certain treatment units. Such units, that registered concentrated infections, should have been the least susceptible as compared to other units with higher risk of outbreak.

• A distinctive point in the epidemiological study of this outbreak, is that the outbreak was localized to this particular hospital and not observed in any of the other hospitals in the city of Benghazi.

• Indwelling catheters were never imported by the hospital's administration and were not used by the medical staff in any medical treatments. Furthermore there is no evidence for the reuse of syringes or any disposable sharp objects at the said hospital. This refutes what was stated in Montagnier and Colizzi Report.

• The gene analysis of the virus causing the disease. established the virus as unique and was not previously registered at the Gene Bank.

• The incidence of large number of infected children is a strange accident and is difficult to explain as a medical accident that is a result of the misuse or lack of medical instruments.

• The scientific reports submitted by foreign experts which support the assumption of a nosocomial infection, lack epidemiological evidence and scientific proof.

• Laboratory analysis of the plasma vials proved that they were contaminated because of the presince of antibodies to the HIV antigens.

• The mortality rate (10.6%) of the infected children (to date) is high and indicates strong infections. The laboratory results of the infected children conducted following their arrival in Switzerland for treatment indicated high viremia. This type of infection does not correlate to nosocomial infections or non-deliberate negligence.

• The direct cause of mortality among the infected children was HIV (AIDS) and accompanying opportunistic infections.

Conclusion:

Upon examining the scientific attached papers, medical reports and defense memoranda: with respect to the scientific view and according to known scientific practices, the National Experts Committee deems the outbreak of AIDS in the Al-Fateh Childrens Hospital as not having occurred as a result of a nosocomial infection and having not resulted because of the misuse and/or the reuse of medical instruments. Furthermore, the data available to us did not contradict the possibility of a deliberate transmission of HIV to the infected children.

Dr. Amina Saleh Abusidra

Dr. Othman Al-Shibani Al-Zentani

Dr. Mohamed Dhao Ighniah

Dr. Ibrahim Abdusalam Abeid

Dr. Osama Awadh Al-Zwai

Sunday December 28, 2003

[edit] Genetic analysis study published in Nature

On December 7, 2006, the influential science journal Nature acting on a request from Lawyers Without Borders published a new study which examined the mutation history of the HIV found in blood samples from some of the children, and concluded that a common ancestor of the strains that infected the children had been present in Libya well before the six defendants arrived in Libya. The study was based on statistical models of the rate of evolution in HIV derived from previous unrelated outbreaks.^[72][73][74] The publication coincided with an editorial campaign by Nature calling for the release of the defendants and was widely publicized. As of January 4, 2007 the Libyan government had not yet responded to the study, but the head of the association of the HIV infected children in the country claimed that the study had no scientific value.^[75]

[edit] Refutation in The Libyan Journal of Medicine

Omar Bagasra, MD, PhD Department of Biology, South Carolina Center for Biotechnology

Mohammad Alsayari, MD South Carolina Center for Biotechnology

The Case of the Libyan HIV-1 Outbreak^[76]

[edit] Professor Luc Montagnier letter to Muammar Gaddafi

Paris, 01/07/04

Du : Pr Luc Montagnier

Au : Colonel Gaddafi, Leader of the Great Socialist People’s Libyan Arab Jamahiriya

Very Honored Leader,

I permit myself to write to you about the death sentence by the Court of Benghazi of five Bulgarian nurses and a Palestinian doctor, shown to have intentionally infected with the AIDS virus, 420 children at the Benghazi pediatric Hospital in 1998. I was commissioned as an expert by the Foundation which bears your name and directed by your son, Mr. Saif El Islam El Gaddafi, to seek the causes of this tragedy. Together with my colleague, Vittorio Colizzi of the University of Rome, we made as detailed an analysis as possible which concluded instead, that it was a series of accidental infections by a unique, very infectious, stock of virus. There is, in any case, a serious doubt about the responsibility of the condemned personnel. This is why, as a co-discoverer of the AIDS virus and based on experience of more than twenty years with this virus, I permit myself to ask you for mercy on the condemned, to allow them the benefit of the doubt. I think that your decision in this direction could only enhance the good image of Libya in the world. Allow me to briefly explain to you a scientific argument against the thesis advocated to the court of a deliberate use of the virus for criminal purposes. The AIDS virus is extremely variable. It is divided into sub-types A, B, C, D, E, F, G which have a different geographical distribution in the world. For each infected adult patient there are small variations in the virus, but these do not change its classification in the sub-type. But one realizes, in Africa and in China in particular, that if a patient is infected simultaneously by two viruses of a different sub-type, for example A and G, within the cells of the patients there is a mixture of genes of the two viruses leading to the emergence of a third sub-type, a recombinant of the first two called A/G. This capacity of recombination is a natural, intrinsic property of the AIDS virus. Recombinant A/G stocks have a better capacity to multiply among west African patients, therefore the majority of the viruses isolated from patients of this area of the world are now A/G. Several of these viruses were analyzed in detail at the molecular level and their sequences - slightly different between them - were deposited in a data bank. However, the analysis of the Benghazi stock that we carried out, like that carried out before by our Swiss colleagues of Geneva Hospital and Italian colleagues of Spallanzani Hospital, showed that while belonging to sub-type A/G, it differed somewhat from the already known stocks isolated from other adult African patients in other laboratories. This, in my opinion, contradicts the hypothesis that somebody had access to laboratory stock of A/G for multiplying and injecting the children of Benghazi. If this stock had been manipulated by man, it should have been detected by our analysis, which indeed is carried on at present in order to cover all genes of the virus. Most probable is that this dramatic chain of contamination started from a African child infected by his mother at birth, lodged at the hospital in 1997 or before. This stock was then accidentally dispersed to other children at the hospital due to bad sterilization practices. When the doctors of the hospital realized presence of HIV, they rectified these practices and the transmissions apparently ceased. The fact that the stock kept its initial characteristics in the children when it was analyzed is due perhaps to the fact that it is very virulent and does not induce an immune response in the child which selects variants.

In the hope of a favorable intervention on your part, I ask you to receive, honored Leader, the assurance of my respect

Pr Luc Montagnier^[77]

[edit] Bagasra et al response letter to the previous scientific reports

Prof Omar Bagasra and his group discussed in details the previous published reports and ask for examining the CD4+ T lymphocytes of the infected children to exclude the possibility of the intentional infection with HIV.^[78]

[edit] Timelines

See [17] and [18] and [19]

[edit] See also

• Muammar al-Gaddafi

[edit] References

[edit] External links

• Petition in Support of The Bulgarian Nurses, Latest News on the trial
• The European-Libyan controversy over of the handling of the case of Pan Am flight 103 by the Scottish and the Benghazi HIV case by the Libyan judiciary: Clash between legal cultures or political power game? 14 February 2007. Statement by Dr. Hans Köchler, UN observer at the Lockerbie trial
• NY Times article with evidence, December 20, 2006
• Medics sentenced to death in Libya (Nature News), 19 December 2006
• Nature Special Report: 'A Shocking Lack of Evidence'
• Al Jazeera story December 19, 2006
• Guardian update December 17, 2006
• Reuters alert December 16, 2006
• Chronology up to December 6, 2006, by Reuters
• The Trial in Libya - extensive chronology up to December, 2004
• Medical Workers' Trial is Test Case for Libya's Progress - December 13, 2006
• Form to send an email to Libyan officials
• The HIV Libya case resource page, October 2006 by Declan Butler, senior reporter at Nature
• Updates on the HIV trial in Libya, by Declan Butler, senior reporter at Nature
• Nature special focus on Libya case
• Documentary by Mickey Grant about the Bulgarian Nurses in Libya
• Der Spiegel newsarticle of 9 November 2005
• Quiet diplomacy is not enough, an article by the British Medical Journal.
• (French) Letter from Luc Montagnier to Muammar al-Qaddafi after the death sentence
• (French) Interview with the professor Luc Montagnier
• (French) European parliament report on human rights in Libya (PDF format, 32 KB)
• report2004 Amnesty International report on human rights in Libya
• report2005 Anmesty International on Libya, including the health workers
• Physicians for Human Rights campaign - lobbying on behalf of the accused
• The Bulgarian Medics Solidarity Project - activist group in Britain lobbying to free the accused
• Libya lifts 'HIV medics' sentence
• Relief over Libya medics reprieve
• New trial for Libyan HIV medics
• Pictures and profiles of the defendants
• Sending Christmas cards to the nurses